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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000868

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Nadia MediaPersonick Sex Female

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

Name of Father Iwan Pisaniuk - Personick MAIDEN NAME of Mother Vera Kendzierski

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Nadie Media Hellier Address of Applicant 69 Paling Court, Hamilton, Ontario Date January 5, 1980

Relationship of Applicant to child Same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Nadia MediaPersonick

Born at Sydney in the County of Cape Breton

That Nadia MediaPersonick Whose Birth is sought to be registered was

born at Sydney Cape Breton County on April 8, 1921

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

I am the Mother of Nadia Media Hillier (whose maiden name was Personick)

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