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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000385

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 26, 1923 Place of Birth River HebertCounty of Cumberland

Name of Father Basil Kewachuk MAIDEN NAME of Mother Mary Dembrosky

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

Residence of Father when child was born River Hebert Cumberland Co. Ns Present address of Father Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant John Kewachuk Address of Applicant RR #3, Pugwash, Cumberland Co., NS Date 24 April 1970

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at River Hebert in the County of Cumberland

That JohnKewachuk Whose Birth is sought to be registered was

born at River Hebert Cumberland County on June 26, 1923

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

An extract from the register of Baptism deposited at St. Thomas Aquinas Rectory, Joggins, NS signed by the Rev. J. D. Curry with Parish Seal.

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