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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91700669

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth March 28, 1922 Place of Birth New WaterfordCounty of Cape Breton

Name of Father Francis Juricny MAIDEN NAME of Mother Mary Kutanek

Residence of Father when child was born New Waterford, Cape Breton Co., NS Present address of Father Shadyside, Ohio

Occupation of Father at Birth of child Miner Place of birth of Father Czeckoslovakia

Race Name and present address of Physician in attendance at birth

Signature of Applicant Rev. R. J. McSween Address of Applicant New Waterford, Cape Breton Co., NS Date 15 November 1943

Relationship of Applicant to child None

AFFIDAVIT

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

Born at New Waterford in the County of Cape Breton

That MaryJuricny Whose Birth is sought to be registered was

born at New Waterford Cape Breton County on March 28, 1922

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

Birth record kept in the books of Mount Carmel Parish, New Waterford, NS and contained the particulars mentioned, namely that Mary Juricny was born at New Waterford, March 28, 1922.

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