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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100150

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Frederick WymanJeffers Sex Male

Date of Birth September 21, 1922 Place of Birth StewiackeCounty of Colchester

Name of Father Wyman Richardson Jeffers MAIDEN NAME of Mother Harriet Jane Ramsey

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

Residence of Father when child was born Stewiacke, Colchester Present address of Father

Occupation of Father at Birth of child Place of birth of Father Peabody, Massachusetts, USA

Race Name and present address of Physician in attendance at birth

Signature of Applicant F. W. Jeffers Address of Applicant RR #2, Sherbrooke, Guysborough, B0J 3C0 Date 24 April 2003

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Frederick WymanJeffers

Born at Stewiacke in the County of Colchester

That Frederick WymanJeffers Whose Birth is sought to be registered was

born at Stewiacke Colchester County on September 21, 1922

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

Birth certificate

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