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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91600884

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 15, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Nicholas Hoysa Sr. MAIDEN NAME of Mother Tekla Staraznk

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

Occupation of Father at Birth of child Steel Worker Place of birth of Father Russia

Race Name and present address of Physician in attendance at birth

Signature of Applicant Tekla Lubineski Address of Applicant 56 Frederick Street, Sydney, Cape Breton Co., NS Date 27 April 1942

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That NicholasHoysa Whose Birth is sought to be registered was

born at Sydney Cape Breton County on December 15, 1920

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

I am his mother and well recall the date of his birth

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