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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000464

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Alexander KeithJackson Sex Male

Date of Birth July 3, 1924 Place of Birth Upper North SydneyCounty of Cape Breton

Name of Father Frederick Samuel Jackson MAIDEN NAME of Mother Frances Logan

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

Residence of Father when child was born Upper North Sydney, Cape Breton Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Upper North Sydney, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sidney Jackson Address of Applicant Upper North Sydney, Cape Breton Co., NS Date 28 May 1974

Relationship of Applicant to child Uncle

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Alexander KeithJackson

Born at Upper North Sydney in the County of Cape Breton

That Alexander KeithJackson Whose Birth is sought to be registered was

born at Upper North Sydney Cape Breton County on July 3, 1924

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

I am an Uncle of the said Keith Alexander Jackson and am positive that the date of his birth was the 3rd day of July, 1924

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