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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000910

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth July 7, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Nykola Bereziuk MAIDEN NAME of Mother Daria Pisaniuk

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 Sydney Steel Plant Place of birth of Father Ukraine

Race Name and present address of Physician in attendance at birth

Signature of Applicant Catherine Bereziuk Noel Address of Applicant RR1 Ste 13, Site 7, Tracadie, New Brunswick Date December 16, 1980

Relationship of Applicant to child n/a

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That CatherineBereziuk Whose Birth is sought to be registered was

born at Sydney Cape Breton County on July 7, 1921

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

From information received from my parents and also from my original baptism certificate which is hereto annexed and marked "A" as class A evidence.

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