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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000811

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary GladysJackson Sex Female

Date of Birth September 8, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father Noble Jackson MAIDEN NAME of Mother Margaret Jackson

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

Residence of Father when child was born Glace Bay, Cape Breton Present address of Father

Occupation of Father at Birth of child Carpenter Place of birth of Father Aylesford, Kings

Race Name and present address of Physician in attendance at birth

Signature of Applicant gladys M. Sanford Address of Applicant Apt. 4, Building 57, Westgrove Place, Halifax Date 5 June 1980

Relationship of Applicant to child one and same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary GladysJackson

Born at Glace Bay in the County of Cape Breton

That Mary GladysJackson Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on September 8, 1922

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

Baptism certificate

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