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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000746

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 3, 1924 Place of Birth SydneyCounty of Cape Breton

Name of Father Joseph Keller MAIDEN NAME of Mother Mary Cziperle

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

Residence of Father when child was born 40 Lingan Road, Sydney, Cape Breton Co., NS Present address of Father

Occupation of Father at Birth of child Steel Worker Place of birth of Father Hungary

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sharon M. Keller Address of Applicant 380 Lingan Road, Sydney, Cape Breton Co., NS Date 9 March 1983

Relationship of Applicant to child Daughter

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That GeorgeStephen Whose Birth is sought to be registered was

born at Sydney Cape Breton County on June 3, 1924

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

Baptismal

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