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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

66700255

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth November 2, 1919 Place of Birth SydneyCounty of Cape Breton

Name of Father George Pizok MAIDEN NAME of Mother Stella Rsipo

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

Residence of Father when child was born Sydney Present address of Father 55 Ferris St.

Occupation of Father at Birth of child Store keeper Place of birth of Father Sydney

Race Name and present address of Physician in attendance at birth Dr. G. Nathanson

Signature of Applicant George Pizok Address of Applicant 55 Ferris St., Sydney Date 15 November 1919

Relationship of Applicant to child father

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That MaryPizok Whose Birth is sought to be registered was

born at Sydney Cape Breton County on November 2, 1919

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

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