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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000417

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth February 7, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Nykola Worobec MAIDEN NAME of Mother Katheryna Paqut

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

Residence of Father when child was born Sydney Present address of Father Dead

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

Race Eurasian Name and present address of Physician in attendance at birth

Signature of Applicant Peter Worobec Address of Applicant 16 Lynd Ave. Date July 22, 1965

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That PeterWorobec Whose Birth is sought to be registered was

born at Sydney Cape Breton County on February 7, 1920

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

Certificate of Baptism

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