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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000580

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth December 27, 1924 Place of Birth SydneyCounty of Cape Breton

Name of Father Valentine Kokoszka MAIDEN NAME of Mother Rosie Wojcik

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 Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Wanda McKinnon Address of Applicant 7 Fairview Street, Sydney, Cape Breton Co., NS Date 24 April 1978

Relationship of Applicant to child Same

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That WandaKokoszka Whose Birth is sought to be registered was

born at Sydney Cape Breton County on December 27, 1924

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

Copy of certificate of baptism, enclosed herein

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