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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000872

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of JohnNahorniak Sex Male

Date of Birth May 1, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Elias Nahorniak MAIDEN NAME of Mother Veronica Gadzuk

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant John Nahorniak Address of Applicant RR #3, Valley Road, Richmond, Quebec, J0B 2H0 Date 18 November 1981

Relationship of Applicant to child Himself

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That JohnNahorniak Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 1, 1922

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

My parents always told me that my birth date was May 1st, 1922. I tried to obtain my birth certificate from the church where I was baptized, but it has burnt.

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