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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000349

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of MaxDavid Sex Male

Date of Birth November 8, 1921 Place of Birth New GlasgowCounty of Pictou

Name of Father Morris David MAIDEN NAME of Mother Jennie Jacobson

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

Residence of Father when child was born North Albert St. New Glasgow Present address of Father deceased

Occupation of Father at Birth of child Merchant Place of birth of Father Lithuania

Race Hebrew Name and present address of Physician in attendance at birth Dr. John

Signature of Applicant Jennie David Address of Applicant 7004 Churchill Drive, Halifax Date July 20, 1965

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of MaxDavid

Born at New Glasgow in the County of Pictou

That MaxDavid Whose Birth is sought to be registered was

born at New Glasgow Pictou County on November 8, 1921

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

That I am his Mother

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