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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000435

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth May 11, 1923 Place of Birth SydneyCounty of Cape Breton

Name of Father John Mroz MAIDEN NAME of Mother Mary Piskorz

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 J. Mroz Address of Applicant 1595 Edward Street, Halifax, NS Date 31 May 1972

Relationship of Applicant to child Nephew

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That MartinaMroz Whose Birth is sought to be registered was

born at Sydney Cape Breton County on May 11, 1923

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

Baptism National Registration

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