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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000894

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 2, 1923 Place of Birth MiraCounty of Cape Breton

Name of Father Joseph Mrazek MAIDEN NAME of Mother Mary Secora

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

Residence of Father when child was born Hornes Road Mira Cape Breton Co. Ns Present address of Father Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Rudolph Mrazek Address of Applicant RR #2, Marion Bridge (Hornes Road, Mira, Cape Breton Co., NS B0A 1P0) Date 23 May 1984

Relationship of Applicant to child Applicant

AFFIDAVIT

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

Born at Mira in the County of Cape Breton

That RudolphMrazek Whose Birth is sought to be registered was

born at Mira Cape Breton County on April 2, 1923

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

Certificate of baptism enclosed

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