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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000546

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 21, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Michael Kokoszka MAIDEN NAME of Mother Maria Golonka

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 Labourer Place of birth of Father Poland

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

Signature of Applicant Anna Plewa Address of Applicant Ontario Date May 3, 1971

Relationship of Applicant to child child herself

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That AnnaKokoszka Whose Birth is sought to be registered was

born at Sydney Cape Breton County on April 21, 1920

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

The birth was indicated in Baptism Certificate issued by St. Mary's Church, Sydney, which certificate has been forwarded previously.

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