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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

41200047

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John William HerbertLane Sex Male

Date of Birth October 10, 1919 Place of Birth HalifaxCounty of Halifax

Name of Father George William Lane MAIDEN NAME of Mother Lizzie Winnifred Spears

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

Residence of Father when child was born Halifax Present address of Father 26R Salter St.

Occupation of Father at Birth of child Automobile repair man Place of birth of Father Owlshead

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

Signature of Applicant Lizzie Winnifred Lane Address of Applicant 26R Salter St. Date 08 November 1919

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John William HerbertLane

Born at Halifax in the County of Halifax

That John William HerbertLane Whose Birth is sought to be registered was

born at Halifax Halifax County on October 10, 1919

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

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