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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000687

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Eva WinnibelleCorkum Sex Female

Date of Birth May 22, 1921 Place of Birth New CornwallCounty of Lunenburg

Name of Father James Alvin Corkum MAIDEN NAME of Mother Lizzie Frances Falkenham

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

Residence of Father when child was born Newburn Present address of Father deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Newburn

Race Name and present address of Physician in attendance at birth

Signature of Applicant Lizzie F. Corkum Address of Applicant Oakland Date October 2, 1974

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Eva WinnibelleCorkum

Born at New Cornwall in the County of Lunenburg

That Eva WinnibelleCorkum Whose Birth is sought to be registered was

born at New Cornwall Lunenburg County on May 22, 1921

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

Lizzie Corkum is the Mother of Eva Winnibelle Corkum

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