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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000751

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 17, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Joseph  Pierzynowski MAIDEN NAME of Mother Josephine Orkish

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 Steelworker Place of birth of Father Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Joan McMahon Address of Applicant Halifax Date December 31, 1975

Relationship of Applicant to child niece

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That TeofilPierzynowski Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 17, 1920

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

Baptismal Marriage Extract

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