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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000576

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 3, 1923 Place of Birth Glace BayCounty of Cape Breton

Name of Father Benjamin Siegel MAIDEN NAME of Mother Dora Fine

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

Residence of Father when child was born Glace Bay Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Merchant Place of birth of Father Odessa, USSR

Race Name and present address of Physician in attendance at birth

Signature of Applicant Dora Siegel Address of Applicant 44 Charles Street West, Toronto, Ontario, M4Y 1R7 Date 28 July 1976

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That JosephSiegel Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on June 3, 1923

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

Attached, Glace Bay General Hospital Birth Certificate

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