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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000945

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of LeoChernin Sex Male

Date of Birth February 7, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father William Chernin MAIDEN NAME of Mother Minnie Godinsky

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 Deceased

Occupation of Father at Birth of child Merchant Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant L. Chernin Address of Applicant Date July 1983

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That LeoChernin Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on February 7, 1922

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

1. On the basis of the school certificate 2. Common family knowledge 3. I am his sister (Ruth Shane)

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