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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000642

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Francis JosephKellof Sex Male

Date of Birth January 3, 1922 Place of Birth Sydney MinesCounty of Cape Breton

Name of Father Frank Kellof MAIDEN NAME of Mother Helen Fayad

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

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

Occupation of Father at Birth of child Merchant Place of birth of Father Zahle, Lebanon

Race Name and present address of Physician in attendance at birth

Signature of Applicant S. J. Khattar Address of Applicant Sydney, Cape Breton Date 28 June 1977

Relationship of Applicant to child Cousin

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Francis JosephKellof

Born at Sydney Mines in the County of Cape Breton

That Francis JosephKellof Whose Birth is sought to be registered was

born at Sydney Mines Cape Breton County on January 3, 1922

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

Family history and baptismal certificate attached - marked "A"

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