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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100171

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jessie MabelBoomer Maynard Sex Female

Date of Birth June 3, 1921 Place of Birth BrookfieldCounty of Colchester

Name of Father   MAIDEN NAME of Mother Florence Letitia Boomer

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jessie Mabel Grant Address of Applicant RR2 Brookfield Date February 1986

Relationship of Applicant to child JMG

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jessie MabelBoomer Maynard

Born at Brookfield in the County of Colchester

That Jessie MabelBoomer Maynard Whose Birth is sought to be registered was

born at Brookfield Colchester County on June 3, 1921

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

Attached supporting documents from: Public Archives of Nova Scotia, Note from Dr. Charles, Letter from retired School Teacher Freda A. Barnton

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