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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000944

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Theodore FordJones Sex Male

Date of Birth July 5, 1924 Place of Birth Molega Gold MinesCounty of Queens

Name of Father Thomas Stephen Jones MAIDEN NAME of Mother Jessie Pearl Whynott

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

Residence of Father when child was born Molega Present address of Father deceased

Occupation of Father at Birth of child Gold Mine Worker Place of birth of Father West Caledonia

Race Name and present address of Physician in attendance at birth

Signature of Applicant T.F. Jones Address of Applicant Kingston Date March 29, 1989

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Theodore FordJones

Born at Molega Gold Mines in the County of Queens

That Theodore FordJones Whose Birth is sought to be registered was

born at Molega Gold Mines Queens County on July 5, 1924

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

I am his Mother

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