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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000866

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jean MarieJensen Sex Female

Date of Birth February 22, 1923 Place of Birth Glace BayCounty of Cape Breton

Name of Father Robert Jensen MAIDEN NAME of Mother Mary Baker

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

Residence of Father when child was born Main Street Glace Bay Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Glace Bay, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jean M. MacNeill Address of Applicant 14924 Athol Street, Fontane, California, 92335, USA Date 15 April 1983

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jean MarieJensen

Born at Glace Bay in the County of Cape Breton

That Jean MarieJensen Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on February 22, 1923

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

I had been told by my parents that I was born on February 22, 1923 in Glace Bay, NS, Canada. I have used that information all my life on official records for school, church, marriage, social security and citizenship (certificate of Naturalization #939677 entered in Superior court of San Bernardino, California, USA on February 17, 1972)

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