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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000554

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth February 17, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Michael Humeniuk MAIDEN NAME of Mother Paraska Kosowych

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

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

Occupation of Father at Birth of child Steel Worker (Dosco) Place of birth of Father Husiatyn, Poland (Ternopil)

Race Name and present address of Physician in attendance at birth

Signature of Applicant Lois Butt Address of Applicant 57 Bryan Street, Sydney, Cape Breton Date 5 September 1975

Relationship of Applicant to child None

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That StephenHumeniuk Whose Birth is sought to be registered was

born at Sydney Cape Breton County on February 17, 1922

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

Certificate of birth and baptism of Holy Ghost Church of Sydney hereto attached.

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