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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000677

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John NewtonHazel Sex Male

Date of Birth March 9, 1920 Place of Birth Baxters HarbourCounty of Kings

Name of Father James Joshua Hazel MAIDEN NAME of Mother Ethel Rose Rand

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Baxter's Harbour Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Arlington

Race White Name and present address of Physician in attendance at birth Deceased

Signature of Applicant John Newton Hazel Address of Applicant Falmouth Date December 20, 1973

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John NewtonHazel

Born at Baxters Harbour in the County of Kings

That John NewtonHazel Whose Birth is sought to be registered was

born at Baxters Harbour Kings County on March 9, 1920

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

I am his mother and remember the date of birth as above. Census 1921 Census 1931 - Ethel Rose Sheffield

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