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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000196

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Elizabeth ElsieZagwolski Sex Female

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

Name of Father Cornel Zagwolski MAIDEN NAME of Mother Anna Fedyshyn

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

Residence of Father when child was born 14 Ferris St. Sydney Present address of Father deceased

Occupation of Father at Birth of child Steelworker Place of birth of Father Austria

Race White Name and present address of Physician in attendance at birth Dr. MacRae

Signature of Applicant Anna Zagwolski Address of Applicant 14 Ferris St. Sydney Date February 12, 1955

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Elizabeth ElsieZagwolski

Born at Sydney in the County of Cape Breton

That Elizabeth ElsieZagwolski Whose Birth is sought to be registered was

born at Sydney Cape Breton County on September 8, 1921

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

I am her mother, and her Baptismal Certificate is attached.

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