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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700537

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Evelyn GertrudeJessome Sex Female

Date of Birth October 31, 1919 Place of Birth BridgeportCounty of Cape Breton

Name of Father Raymond Jessome MAIDEN NAME of Mother Mary Elizabeth Cadegon

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

Residence of Father when child was born Dominion Present address of Father

Occupation of Father at Birth of child Miner Place of birth of Father

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

Signature of Applicant Dr. W.W. Potter Address of Applicant Dominion Date 01 November 1919

Relationship of Applicant to child doctor

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Evelyn GertrudeJessome

Born at Bridgeport in the County of Cape Breton

That Evelyn GertrudeJessome Whose Birth is sought to be registered was

born at Bridgeport Cape Breton County on October 31, 1919

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

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