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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000671

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jessie SusanDickson Sex Female

Date of Birth January 8, 1923 Place of Birth SydneyCounty of Cape Breton

Name of Father   MAIDEN NAME of Mother Mary Catherine Dickson

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Jessie Address of Applicant 1757 University Avenue W, Apt 24 Date 22 June 1978

Relationship of Applicant to child One and the same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jessie SusanDickson

Born at Sydney in the County of Cape Breton

That Jessie SusanDickson Whose Birth is sought to be registered was

born at Sydney Cape Breton County on January 8, 1923

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

I am an older sister of the applicant and I was present at the time of the birth of my sister and I remember the circumstances.

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