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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000379

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 3, 1922 Place of Birth River HebertCounty of Cumberland

Name of Father Mark Beverly Slack MAIDEN NAME of Mother Ida may Hudson

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

Residence of Father when child was born River Hebert, Cumberland Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Folly Lake, Colchester

Race Name and present address of Physician in attendance at birth

Signature of Applicant J. W. Hazen Slack Address of Applicant 255 MacDonell Avenue, Toronto, Ontario Date 27 March 1969

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John William HazenSlack

Born at River Hebert in the County of Cumberland

That John William HazenSlack Whose Birth is sought to be registered was

born at River Hebert Cumberland County on June 3, 1922

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

I am his oldest living sister and was present at his birth

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