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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600321

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 1, 1922 Place of Birth SydneyCounty of Cape Breton

Name of Father Paul Sophik MAIDEN NAME of Mother Lana Kowalko

Residence of Father when child was born Sydney, Cape Breton Co., NS Present address of Father Windsor, Ontario

Occupation of Father at Birth of child Labourer Place of birth of Father Russia

Race Name and present address of Physician in attendance at birth

Signature of Applicant Alek Sophik Address of Applicant Glace Bay, Cape Breton Co., NS Date 19 November 1934

Relationship of Applicant to child Grandfather

AFFIDAVIT

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

Born at Sydney in the County of Cape Breton

That MarieSophik Whose Birth is sought to be registered was

born at Sydney Cape Breton County on January 1, 1922

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

She was born at my residence and I was home at the time.

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