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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000572

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth July 1, 1924 Place of Birth SydneyCounty of Cape Breton

Name of Father Dmytro Potribny MAIDEN NAME of Mother Alexandra Potribny

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

Residence of Father when child was born 148 Supper Street, Sydney, Cape Breton Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Steel Worker Place of birth of Father Romania

Race Name and present address of Physician in attendance at birth

Signature of Applicant Annie Potribny Address of Applicant 74 Lingan Road, Sydney, Cape Breton Co., NS Date 18 April 1978

Relationship of Applicant to child Sister

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That JohnPotribny Whose Birth is sought to be registered was

born at Sydney Cape Breton County on July 1, 1924

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

1. 1940 Census 2. City of Sydney School records

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