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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000304

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roy StephenStashuk Sex Male

Date of Birth September 19, 1924 Place of Birth Glace BayCounty of Cape Breton

Name of Father Anthony Stashuk MAIDEN NAME of Mother Violet May Willard

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

Residence of Father when child was born Wallace Road, Glace Bay, Cape Breton Co., NS Present address of Father Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant R. S. Stashuk Address of Applicant 427 Dumfries Avenue, Kitchener, Ontario Date 22 June 1967

Relationship of Applicant to child Same

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roy StephenStashuk

Born at Glace Bay in the County of Cape Breton

That Roy StephenStashuk Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on September 19, 1924

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

Certificate of baptism Personal knowledge

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