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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000605

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lorna ElizabethLake Sex Female

Date of Birth May 23, 1921 Place of Birth SummervilleCounty of Hants

Name of Father Embert M. Lake MAIDEN NAME of Mother Martha Mosher

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

Residence of Father when child was born Summerville Present address of Father Falmouth

Occupation of Father at Birth of child Gardner and Seaman Place of birth of Father Summerville

Race Name and present address of Physician in attendance at birth

Signature of Applicant George F. Brison Address of Applicant Cheverie Date January 7, 1976

Relationship of Applicant to child Friend

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lorna ElizabethLake

Born at Summerville in the County of Hants

That Lorna ElizabethLake Whose Birth is sought to be registered was

born at Summerville Hants County on May 23, 1921

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

Census School extract Marriage

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