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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000655

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth September 3, 1923 Place of Birth SydneyCounty of Cape Breton

Name of Father Ivan Shewchuk MAIDEN NAME of Mother Dominica Gruntay

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 Miner Place of birth of Father Ukraine

Race Name and present address of Physician in attendance at birth

Signature of Applicant M. Shewchuk Address of Applicant 4711 River Road, Niagara Falls, Ontario Date 26 June 1978

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That MichaelShewchuk Whose Birth is sought to be registered was

born at Sydney Cape Breton County on September 3, 1923

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

Original certificate of birth and baptism from baptismal register of Ukrainian Greek - Catholic Parish of Holy Ghost, Sydney, NS, dated July 4, 1960.

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