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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000598

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth October 1, 1924 Place of Birth Hornes RoadCounty of Cape Breton

Name of Father Joseph Mrazek MAIDEN NAME of Mother Mary Cecora

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

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

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Amelia Mrazek (O'Neill) Address of Applicant 9 Hickman Street, Glace Bay, Cape Breton Co., NS Date 1 December 1978

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Hornes Road in the County of Cape Breton

That AmeliaMrazek Whose Birth is sought to be registered was

born at Hornes Road Cape Breton County on October 1, 1924

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

I was living at home at the time of my sister's birth - Florence Mrazek

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