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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000537

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 1, 1922 Place of Birth Glace BayCounty of Cape Breton

Name of Father Frank Novak MAIDEN NAME of Mother Sophie Mazek

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

Residence of Father when child was born Glace Bay, Cape Breton Present address of Father Deceased

Occupation of Father at Birth of child Coal Miner Place of birth of Father Poland

Race Name and present address of Physician in attendance at birth

Signature of Applicant Sophie Giles Address of Applicant Antigonish Date 21 May 1975

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Glace Bay in the County of Cape Breton

That SophieNovak Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on April 1, 1922

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

Baptismal Certificate

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