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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000736

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of HarriettaJackolag Sex Female

Date of Birth January 19, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Harry Jackolag MAIDEN NAME of Mother Julia Durwell

Were the Parents married at the time of the Birth? No

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

Occupation of Father at Birth of child Steel Worker Place of birth of Father Russia

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Harrietta (Jackolag) Lanceleve Address of Applicant 3209 Hinchey Avenue, New Waterford, Cape Breton Date 27 March 1979

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That HarriettaJackolag Whose Birth is sought to be registered was

born at Sydney Cape Breton County on January 19, 1922

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

Copy of Records from Childrens Aid Society of Cape Breton

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