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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000276

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of William JosephNickelo Sex Male

Date of Birth August 19, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father Peter Nickelo MAIDEN NAME of Mother Margaret Cooper

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

Residence of Father when child was born Glace Bay, Cape Breton Present address of Father Glace Bay, Cape Breton

Occupation of Father at Birth of child Coal Miner Place of birth of Father Bulgaria

Race Name and present address of Physician in attendance at birth

Signature of Applicant Leo Nickelo Address of Applicant 198 Wallace Road, Glace Bay, Cape Breton Date 16 February 1963

Relationship of Applicant to child Brother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of William JosephNickelo

Born at Glace Bay in the County of Cape Breton

That William JosephNickelo Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on August 19, 1922

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

It is the date shown on the attached certificate of birth and baptism, particulars on which have been taken from the records of St. Johns Church, Glace Bay, Cape Breton

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