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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100100

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of James LaurentJacquard Sex Male

Date of Birth January 7, 1923 Place of Birth YarmouthCounty of Yarmouth

Name of Father Sam Jacquard MAIDEN NAME of Mother Rebecca Fitzgerald

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Theresa Harris Address of Applicant 11 Tano Dr. Highland, New York Date August 24, 2011

Relationship of Applicant to child Sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of James LaurentJacquard

Born at Yarmouth in the County of Yarmouth

That James LaurentJacquard Whose Birth is sought to be registered was

born at Yarmouth Yarmouth County on January 7, 1923

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

Baptismal Certificate

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