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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000237

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jean KatherineThompson Sex Female

Date of Birth April 28, 1922 Place of Birth YarmouthCounty of Yarmouth

Name of Father Fenwick Thompson MAIDEN NAME of Mother Delia Davis

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

Residence of Father when child was born Liverpool, Queens Present address of Father Liverpool, Queens

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jean Katherine McDougall Address of Applicant 53 Broad Street, Sussex, New Brunswick Date 12 June 1958

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jean KatherineThompson

Born at Yarmouth in the County of Yarmouth

That Jean KatherineThompson Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on April 28, 1922

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

School record and Insurance Policy record.

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