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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100146

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of RomaCampagnuola Sex

Date of Birth June 4, 1922 Place of Birth New WaterfordCounty of Cape Breton

Name of Father Vito Campagnuola MAIDEN NAME of Mother Elvira Minello

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

Residence of Father when child was born New Waterford, Cape Breton Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Roma Kush Address of Applicant 2455 Rivard Avenue, Apt. 520, windsor, Ontario, N8T 3B3 Date 22 September 2000

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at New Waterford in the County of Cape Breton

That RomaCampagnuola Whose Birth is sought to be registered was

born at New Waterford Cape Breton County on June 4, 1922

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

Baptism certificate/marriage

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