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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000854

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John LawrenceJacquard Sex Male

Date of Birth April 1, 1923 Place of Birth YarmouthCounty of Yarmouth

Name of Father Forman Jacquard MAIDEN NAME of Mother Clement Cottreau

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

Residence of Father when child was born Yarmouth Ns Present address of Father Deceased

Occupation of Father at Birth of child War Pensioner Place of birth of Father Comeau Hill, Yarmouth Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant John Laurence Jacquard Address of Applicant RR #1, South Ohio, Yarmouth, NS Date 7 April 1983

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John LawrenceJacquard

Born at Yarmouth in the County of Yarmouth

That John LawrenceJacquard Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on April 1, 1923

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

That I John Lawrence Jacquard was born on the 1st day of April 1923 at Yarmouth true to my knowledge.

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