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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000923

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth September 22, 1920 Place of Birth Glace BayCounty of Cape Breton

Name of Father Morris  Gold MAIDEN NAME of Mother Sarah Ein

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

Residence of Father when child was born Glace Bay Present address of Father deceased

Occupation of Father at Birth of child Merchant Place of birth of Father Russia

Race Name and present address of Physician in attendance at birth

Signature of Applicant Paul W. Goldberg Address of Applicant Halifax Date July 25, 1978

Relationship of Applicant to child son

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That MiriamGold Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on September 22, 1920

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

Marriage records Birth records

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