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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000886

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 5, 1923 Place of Birth Glace BayCounty of Cape Breton

Name of Father Michael Andrecyk MAIDEN NAME of Mother Mary Seska

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Michael Andrecyk Address of Applicant 3 Elmwood Street, St. Catharines, Ontario, L2R 2T5 Date 23 February 1984

Relationship of Applicant to child Same Person

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That MichaelAndrecyk Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on October 5, 1923

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

I have obtained a copy of birth and baptismal certificate from St. John the Baptist Roman Catholic Church in Glace Bay, NS. This document is signed by Rev. Hugh McNeil, the priest presently.

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