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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000520

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth February 20, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Fred Yuskow MAIDEN NAME of Mother Josephine Cherka

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

Residence of Father when child was born Oshawa, Ontario Present address of Father 146 1/2 Olive Avenue, Oshawa, Ontario

Occupation of Father at Birth of child Barber Place of birth of Father ukraine

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Derry Address of Applicant 16 Blue Spruce Lane, Thornhill, Ontario Date 6 June 1974

Relationship of Applicant to child Applicant applying to register her own birth

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That MaryYuskow Whose Birth is sought to be registered was

born at Sydney Cape Breton County on February 20, 1922

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

School records, marriage certificate and marriage certificate application form.

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