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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90701070

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Stanley JohnWithouski Sex Male

Date of Birth November 24, 1920 Place of Birth StellartonCounty of Pictou

Name of Father Stanley Withouski MAIDEN NAME of Mother Anna Withouski

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

Residence of Father when child was born 44 Bunker Hill, Stellarton Present address of Father 1338 Ellrose Avenue, Windsor, Ontario

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

Race Polish Name and present address of Physician in attendance at birth none

Signature of Applicant Stanley Withouski Address of Applicant 1338 Ellrose Avenue, Windsor, Ontario Date 20 November 1939

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Stanley JohnWithouski

Born at Stellarton in the County of Pictou

That Stanley JohnWithouski Whose Birth is sought to be registered was

born at Stellarton Pictou County on November 24, 1920

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

signed by Anna Withouski

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