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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100248

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth February 8, 1920 Place of Birth SydneyCounty of Cape Breton

Name of Father Martin Zak MAIDEN NAME of Mother Rosalia 

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

Residence of Father when child was born Sydney Present address of Father deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Joseph Zak Address of Applicant Colheath Date March 6, 1984

Relationship of Applicant to child self

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That JosephZak Whose Birth is sought to be registered was

born at Sydney Cape Breton County on February 8, 1920

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

Baptism Certificate & Adoption Order

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