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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000781

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 10, 1920 Place of Birth SpringhillCounty of Cumberland

Name of Father James Chuppa MAIDEN NAME of Mother Melania Szpeuik

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

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

Occupation of Father at Birth of child Coal miner Place of birth of Father Kalush, Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Zajac Address of Applicant Sydney Date April 29, 1976

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Springhill in the County of Cumberland

That MaryChuppa Whose Birth is sought to be registered was

born at Springhill Cumberland County on April 10, 1920

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

Mary Chuppa (Zajac) is my younger sister. I will be 58 years old on May 28 and Mary is 56 years of age now. We grew up together in our parents' home. We all know that Mary's Birthday is April 10. - Peter Chuppa

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