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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000954

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of ClarenceKeller Sex Male

Date of Birth July 1, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Joseph Keller MAIDEN NAME of Mother Mary  Izipella

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

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

Occupation of Father at Birth of child Merchant Place of birth of Father Austria-Hungary

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ada Keller Address of Applicant Sydney Date November 18, 1978

Relationship of Applicant to child wife

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That ClarenceKeller Whose Birth is sought to be registered was

born at Sydney Cape Breton County on July 1, 1920

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

This is my husband's birth.

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