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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000533

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Sophie HelenZamojski Sex Female

Date of Birth March 25, 1920 Place of Birth StellartonCounty of Pictou

Name of Father Stanislaw Zamojski MAIDEN NAME of Mother Mary Magdelena Marcot

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

Residence of Father when child was born Stellarton Present address of Father 751 Vine Avenue

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 Dr. Whittman

Signature of Applicant Sophie H. Taylor Address of Applicant 16 Fisrt Ave., Levack Date

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Sophie HelenZamojski

Born at Stellarton in the County of Pictou

That Sophie HelenZamojski Whose Birth is sought to be registered was

born at Stellarton Pictou County on March 25, 1920

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

The information stated on the Baptismal Certificate was given to Our Lady of Lourdes Church at Stellarton by my father at the time of baptism which took place on April 4, 1920

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