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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000745

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Wanda MaryNiedzielski Sex Female

Date of Birth November 29, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father Anthony Niedzielski MAIDEN NAME of Mother Mary Michalik

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

Residence of Father when child was born Glace Bay, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Wanda M. Yurchesyn Address of Applicant Box 25, Whitney Pier PO, Sydney, Cape Breton Date 27 March 1979

Relationship of Applicant to child Self applicant

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Wanda MaryNiedzielski

Born at Glace Bay in the County of Cape Breton

That Wanda MaryNiedzielski Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on November 29, 1922

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

Birth certificate enclosed.

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