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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000165

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 8, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Peter Melnyk MAIDEN NAME of Mother Anna Zdyblal

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

Residence of Father when child was born Sydney Present address of Father dead

Occupation of Father at Birth of child Steel worker Place of birth of Father Poland

Race White Name and present address of Physician in attendance at birth dead

Signature of Applicant Mrs. Kenneth Jamieson Address of Applicant Date October 16, 1952

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That MaryMelnyk Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 8, 1921

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

Taken from Baptism Certificate

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