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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000597

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Allen HenryMichniak Sex Male

Date of Birth September 10, 1920 Place of Birth HartfordCounty of Cumberland

Name of Father Albert Michniak MAIDEN NAME of Mother Caroline Frank

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

Residence of Father when child was born Hartford, Cumberland Co. Present address of Father deceased

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

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

Signature of Applicant Allen H. Michniak Address of Applicant 8424 Mortenview, Taylor, Michigan Date 18 April 1972

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Allen HenryMichniak

Born at Hartford in the County of Cumberland

That Allen HenryMichniak Whose Birth is sought to be registered was

born at Hartford Cumberland County on September 10, 1920

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

I resided on a farm with my parents in Hartford, Cumberland County, Canada, at the time my brother, Allen Henry Michniak, was born on September 10, 1920. (signed Dorothy Michniak Esser)

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