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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700127

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of George HenryJessome Sex Male

Date of Birth December 19, 1919 Place of Birth Glace BayCounty of Cape Breton

Name of Father Louis Jessome MAIDEN NAME of Mother Annie May Simmons

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Glace Bay Present address of Father

Occupation of Father at Birth of child Painter Place of birth of Father Glace Bay

Race Name and present address of Physician in attendance at birth Dr. F.W. Green

Signature of Applicant Louis Jessome Address of Applicant Glace Bay Date 05 January 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of George HenryJessome

Born at Glace Bay in the County of Cape Breton

That George HenryJessome Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on December 19, 1919

My knowledge of the fact and date of such Birth is based on the following Circumstances:

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