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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000454

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of JennieCarocci Sex Female

Date of Birth May 6, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Angelo Carocci MAIDEN NAME of Mother Filomena Carletti

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

Residence of Father when child was born Sydney Present address of Father Sydney

Occupation of Father at Birth of child Steel Worker Place of birth of Father Italy

Race Italian Name and present address of Physician in attendance at birth Dr. Calder, Sydney

Signature of Applicant Mrs. Jennie White Address of Applicant Toronto Date September 28, 1967

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of JennieCarocci

Born at Sydney in the County of Cape Breton

That JennieCarocci Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 6, 1920

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

according to my Certificate of Birth and Baptism, issued at St. Nicolas Parish, Sydney, dated June 10, 1920, as appears by Certificate issued April 13, 1948.

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