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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90600959

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth February 16, 1921 Place of Birth 55 Ferris Street, SydneyCounty of Cape Breton

Name of Father George Rizok MAIDEN NAME of Mother Stella Rzepa (Rizok)

Residence of Father when child was born 55 Ferris Street, Sydney, Cape Breton Co., NS Present address of Father 100 Ferris Street, Sydney, Cape Breton Co., NS

Occupation of Father at Birth of child Merchant Place of birth of Father Eastern Galicia, Ukraine

Race Name and present address of Physician in attendance at birth

Signature of Applicant George Rizok Address of Applicant 100 Ferris Street, Sydney, Cape Breton Co., NS Date 22 August 1938

Relationship of Applicant to child Father

AFFIDAVIT

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

Born at 55 Ferris Street, Sydney in the County of Cape Breton

That JosephRizok Whose Birth is sought to be registered was

born at 55 Ferris Street, Sydney Cape Breton County on February 16, 1921

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

From records kept of the birth of my children in my family bible

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