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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000235

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth June 2, 1923 Place of Birth SydneyCounty of Cape Breton

Name of Father Charles Karl Dobrucki MAIDEN NAME of Mother Veronica Griszka

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

Residence of Father when child was born Sydney Cape Breton Co. Ns Present address of Father Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Frank Dobrucki Address of Applicant 44 Julian South, Hamilton, Ontario Date 25 July 1958

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That FrankDobrucki Whose Birth is sought to be registered was

born at Sydney Cape Breton County on June 2, 1923

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

Certificate of baptism

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