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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000830

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth September 23, 1923 Place of Birth SydneyCounty of Cape Breton

Name of Father John Bernasky MAIDEN NAME of Mother Martha Kolosnick

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 Dead

Occupation of Father at Birth of child Coal Miner Place of birth of Father Russia

Race Name and present address of Physician in attendance at birth

Signature of Applicant F. B. Ross Address of Applicant 192 Laurier Street, Sydney, Cape Breton Co., NS Date 14 April 1982

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That FeodoraBernasky Whose Birth is sought to be registered was

born at Sydney Cape Breton County on September 23, 1923

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

This is my own birth Church records are in error by one month

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