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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000184

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of EvelynJackson Sex Female

Date of Birth August 8, 1922 Place of Birth YarmouthCounty of Yarmouth

Name of Father   MAIDEN NAME of Mother Alma Crawford

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 Alex Jackson Address of Applicant 190 Creighton Street, Halifax Date 13 August 1954

Relationship of Applicant to child Uncle by marriage

AFFIDAVIT

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

Born at Yarmouth in the County of Yarmouth

That EvelynJackson Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on August 8, 1922

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

Evelyn Jacksons mother died during childbirth. My wife and I took her from the hospital following the birth and have raised her from birth in our own name of Jackson as shown on school records and marriage records. Her birthday has always been observed by us on August 8th each year.

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