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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000800

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of William OscarJackson Sex Male

Date of Birth August 4, 1921 Place of Birth ShelburneCounty of Shelburne

Name of Father Albert Jackson MAIDEN NAME of Mother Christina May Buchanan

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

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

Occupation of Father at Birth of child Labourer Place of birth of Father Clyde River

Race Name and present address of Physician in attendance at birth

Signature of Applicant William O Jackson Mrs. Address of Applicant Shelburne Date March 5, 1979

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of William OscarJackson

Born at Shelburne in the County of Shelburne

That William OscarJackson Whose Birth is sought to be registered was

born at Shelburne Shelburne County on August 4, 1921

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

Certificate of Baptism Marriage Certificate

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