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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600551

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Frances SophroniaDeKouchay Sex Female

Date of Birth March 15, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Michael DeKouchay MAIDEN NAME of Mother Mary Malik

Residence of Father when child was born 158 Maloney Street, Sydney, Cape Breton Co., NS Present address of Father 158 Maloney Street, Sydney, Cape Breton Co., NS

Occupation of Father at Birth of child Steel Worker Place of birth of Father Galicia, Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Michael DeKouchay Address of Applicant 158 Maloney Street, Sydney, Cape Breton Co., NS Date 14 December 1938

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Frances SophroniaDeKouchay

Born at Sydney in the County of Cape Breton

That Frances SophroniaDeKouchay Whose Birth is sought to be registered was

born at Sydney Cape Breton County on March 15, 1922

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

I am the father of Frances Sophronia DeKouchay and was present at my home on 158 Maloney Street on the night of March 15, 1922 where and when she was born.

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