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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000667

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Millicent MargaretJackson Sex Female

Date of Birth August 10, 1922 Place of Birth WestvilleCounty of Pictou

Name of Father William Henry Jackson MAIDEN NAME of Mother Amelia Coppen

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

Residence of Father when child was born Westville, Pictou Present address of Father Westville, Pictou

Occupation of Father at Birth of child Place of birth of Father Sheet Harbour, Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Amelia Jackson Address of Applicant Westville, Pictou Date 31 August 1922

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Millicent MargaretJackson

Born at Westville in the County of Pictou

That Millicent MargaretJackson Whose Birth is sought to be registered was

born at Westville Pictou County on August 10, 1922

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

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