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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000508

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 17, 1921 Place of Birth ClarenceCounty of Annapolis

Name of Father A. Manning Jackson MAIDEN NAME of Mother Marjorie B. Neily

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

Residence of Father when child was born Clarence Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Clarence

Race Caucasian Name and present address of Physician in attendance at birth Dr. Phinney

Signature of Applicant M.P. Neily Address of Applicant Middleton Date December 15, 1972

Relationship of Applicant to child Uncle (administrator of estate)

AFFIDAVIT

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

Born at Clarence in the County of Annapolis

That George DouglasJackson Whose Birth is sought to be registered was

born at Clarence Annapolis County on October 17, 1921

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

1) Report of Lawrencetown School Records 2) Search of Census Records

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