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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000349

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Peter AssadHashem Sex Male

Date of Birth May 21, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Isaac Hashem MAIDEN NAME of Mother Bessie Hashem

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

Residence of Father when child was born Sydney, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Canadian National Railway Employee Place of birth of Father Lebanon

Race Name and present address of Physician in attendance at birth

Signature of Applicant Peter Hashem Address of Applicant 39 Sherriff Avenue, Sydney, Cape Breton Date 20 July 1967

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Peter AssadHashem

Born at Sydney in the County of Cape Breton

That Peter AssadHashem Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 21, 1922

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

Baptism certificate

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