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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000752

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 1, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Ivan Bernasky MAIDEN NAME of Mother Martha Koliznuk

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

Residence of Father when child was born Glace Bay Present address of Father deceased

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

Signature of Applicant Sofia Bernasky McKinnon Address of Applicant 191 Laurier St. Sydney Date June 3, 1978

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That SofiaBernasky Whose Birth is sought to be registered was

born at Sydney Cape Breton County on October 1, 1921

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

This is my own birth

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