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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92800127

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Rosemarie FrancesCzernikieviecz Sex Female

Date of Birth April 22, 1921 Place of Birth SydneyCounty of Cape Breton

Name of Father Julian Czernikieviecz MAIDEN NAME of Mother Mary Allain

Residence of Father when child was born Sydney, Cape Breton Co., NS Present address of Father 1106 King St. W. Toronto, Ontario

Occupation of Father at Birth of child Steelworker Place of birth of Father Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Czernikieviecz Address of Applicant 1106 King St. W. Toronto Date April 18, 1944

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Rosemarie FrancesCzernikieviecz

Born at Sydney in the County of Cape Breton

That Rosemarie FrancesCzernikieviecz Whose Birth is sought to be registered was

born at Sydney Cape Breton County on April 22, 1921

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

I am the mother

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