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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000923

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Toney LeeSheparski Sex Male

Date of Birth March 4, 1923 Place of Birth ThorburnCounty of Pictou

Name of Father John Sheparski MAIDEN NAME of Mother Violet Margaret Chase

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

Residence of Father when child was born Thorburn Pictou Co. Ns Present address of Father Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Toney Lee Sheparski Address of Applicant 442 Brother Street, New Glasgow, Pictou Co., NS Date 3 January 1985

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Toney LeeSheparski

Born at Thorburn in the County of Pictou

That Toney LeeSheparski Whose Birth is sought to be registered was

born at Thorburn Pictou County on March 4, 1923

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

1. I am the elder sister of applicant 2. I recall his birth always being celebrated as March 4, 1923

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