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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000362

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ruby MaeLake Sex Female

Date of Birth July 9, 1921 Place of Birth Newport StationCounty of Hants

Name of Father Kenneth Bazlor Lake MAIDEN NAME of Mother Dolly Alice Dykens

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

Residence of Father when child was born Union Corner Present address of Father Newport

Occupation of Father at Birth of child Railroad Man Place of birth of Father Brookville

Race English Name and present address of Physician in attendance at birth

Signature of Applicant Ruby Mae Lake Address of Applicant Newport Date 19 September 1966

Relationship of Applicant to child Personal

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ruby MaeLake

Born at Newport Station in the County of Hants

That Ruby MaeLake Whose Birth is sought to be registered was

born at Newport Station Hants County on July 9, 1921

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

From information from parents and Bible Entry

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