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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

93401222

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Palmer ZewickLake Sex Male

Date of Birth November 20, 1906 Place of Birth BramberCounty of Hants

Name of Father Alfred Edwin Lake MAIDEN NAME of Mother Elizabeth Jane Macumber

Residence of Father when child was born Bramber Present address of Father Bramber

Occupation of Father at Birth of child Farmer Place of birth of Father Bramber

Race Caucasian Name and present address of Physician in attendance at birth Dr. E.F. Moore

Signature of Applicant Elizabeth Jane Lake Address of Applicant Bramber Date 20 January 1926

Relationship of Applicant to child mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Palmer ZewickLake

Born at Bramber in the County of Hants

That Palmer ZewickLake Whose Birth is sought to be registered was

born at Bramber Hants County on November 20, 1906

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

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