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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100053

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Claude AllisterJack Sex Male

Date of Birth September 1, 1922 Place of Birth SonoraCounty of Guysborough

Name of Father William Thomas Jack MAIDEN NAME of Mother Nora Bell Coles

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

Residence of Father when child was born Sonora, Guysborough Present address of Father Deceased

Occupation of Father at Birth of child Boatman/woodsman Place of birth of Father Sonora, Guysborough

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Dorothy M. Jack Address of Applicant 462 Herring Cove Road, Halifax Date 12 August 1986

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Claude AllisterJack

Born at Sonora in the County of Guysborough

That Claude AllisterJack Whose Birth is sought to be registered was

born at Sonora Guysborough County on September 1, 1922

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

School records Marriage extract Census records

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