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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600697

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 6, 1922 Place of Birth Douglas Avenue, Glace BayCounty of Cape Breton

Name of Father John Kazamel MAIDEN NAME of Mother Agnes Molish

Residence of Father when child was born Douglas Avenue, Glace Bay, Cape Breton Co., NS Present address of Father 7 Warren Street, Glace Bay, Cape Breton Co., NS

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. John Kazamel Address of Applicant 7 Warren Street, Glace Bay, Cape Breton Co., NS Date 28 June 1939

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Douglas Avenue, Glace Bay in the County of Cape Breton

That EdwardKazamel Whose Birth is sought to be registered was

born at Douglas Avenue, Glace Bay Cape Breton County on May 6, 1922

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

I am the child's mother and accompanied is a church certificate of same.

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