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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100003

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 7, 1920 Place of Birth DominionCounty of Cape Breton

Name of Father Joseph Ostrowski MAIDEN NAME of Mother Catherine Adulnack Glos

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Anastasia Ostrowski Address of Applicant Hamilton, Ontario Date June 14, 1979

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Dominion in the County of Cape Breton

That AnastasiaOstrowski Whose Birth is sought to be registered was

born at Dominion Cape Breton County on May 7, 1920

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

I, the Applicant, am the person who now wishes to obtain a delayed Registration of Birth. I have obtained and attached hereto information respecting my birth from this attached Certificate of Baptism

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