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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000066

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth August 28, 1922 Place of Birth Reserve MinesCounty of Cape Breton

Name of Father Morris J. Cohen MAIDEN NAME of Mother Sophie Wineberg

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

Residence of Father when child was born Reserve Mines, Cape Breton Present address of Father Reserve Mines, Cape Breton

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant M. J. Cohen Address of Applicant Reserve Mines, Cape Breton Date 10 May 1948

Relationship of Applicant to child Father

AFFIDAVIT

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

Born at Reserve Mines in the County of Cape Breton

That GoodmanCohen Whose Birth is sought to be registered was

born at Reserve Mines Cape Breton County on August 28, 1922

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

I am the father of the above Goodman Cohen and was at home on the day that the birth occurred

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