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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000497

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of JuliaMiecznik Sex Female

Date of Birth April 13, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Joseph Miecznik MAIDEN NAME of Mother Emily Trojan

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

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

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

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

Signature of Applicant Percy Gaum Address of Applicant Sydney Date August 8, 1969

Relationship of Applicant to child

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That JuliaMiecznik Whose Birth is sought to be registered was

born at Sydney Cape Breton County on April 13, 1920

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

The attached Baptism Certificate

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