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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000989

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth September 7, 1922 Place of Birth DominionCounty of Cape Breton

Name of Father Alexander Gottwald MAIDEN NAME of Mother Mary Olszowiec

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

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

Occupation of Father at Birth of child Coal Miner Place of birth of Father Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Edward Gottwald Address of Applicant 7203 Darcel Avenue, Dominion Date 25 October 1984

Relationship of Applicant to child Same

AFFIDAVIT

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

Born at Dominion in the County of Cape Breton

That EdwardGottwald Whose Birth is sought to be registered was

born at Dominion Cape Breton County on September 7, 1922

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

Certificate of baptism from Church of Immaculate Conception and certified by Pastor A. O. Campbell.

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