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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90500466

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth February 15, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Lazar Konick MAIDEN NAME of Mother Bella Gaum

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

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 Lazar Konick Address of Applicant 146 Prince St. Sydney Date September 3, 1940

Relationship of Applicant to child Father

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That MorrisKonick Whose Birth is sought to be registered was

born at Sydney Cape Breton County on February 15, 1922

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

I am his father. I was at home when he was born and the facts as stated above are correct.

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