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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000916

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 6, 1923 Place of Birth SydneyCounty of Cape Breton

Name of Father Teofil Orkisz MAIDEN NAME of Mother Annie Harbc

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 Plant Worker in Wire Mill Place of birth of Father Krakow, Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mary Kalino Address of Applicant 7785 Serge, LaSalle, Quebec Date 11 December 1984

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That MaryOrkisz Whose Birth is sought to be registered was

born at Sydney Cape Breton County on December 6, 1923

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

Her son and baptismal papers

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