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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700549

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 2, 1919 Place of Birth New WaterfordCounty of Cape Breton

Name of Father Martin Scheponiak MAIDEN NAME of Mother Theodosia Novak

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

Residence of Father when child was born New Waterford Present address of Father

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

Race Name and present address of Physician in attendance at birth Dr. D.J. Hartigan

Signature of Applicant Martin Sheponiak Address of Applicant New Waterford Date 05 November 1919

Relationship of Applicant to child father

AFFIDAVIT

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

Born at New Waterford in the County of Cape Breton

That JadwdyScheponiak Whose Birth is sought to be registered was

born at New Waterford Cape Breton County on October 2, 1919

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

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