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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000540

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 20, 1924 Place of Birth Glace BayCounty of Cape Breton

Name of Father Rudolph Bernitick MAIDEN NAME of Mother Catherine Dobranski

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

Residence of Father when child was born Pugwash, Cumberland Co., NS Present address of Father Oxford, Cumberland Co., NS

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Irene Bernitick Address of Applicant 233 Helen Avenue, Otterburn Heights, Quebec Date 3 June 1977

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That IreneBernitick Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on December 20, 1924

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

Irene was born at home. Attending physician was Dr. Calder and I was present at the moment of her birth (Aunt Genevieve Dobranski)

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