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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000204

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Winnifred JaneLake Sex Female

Date of Birth July 14, 1924 Place of Birth Upper Nine Mile RiverCounty of Hants

Name of Father Percy LeRoy Lake MAIDEN NAME of Mother Lucy Viola Laffin

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

Residence of Father when child was born Upper Nine Mile River, Hants Co., NS Present address of Father Cheverie, Hants Co., NS

Occupation of Father at Birth of child Labourer Place of birth of Father Bramber, Hants Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Lucy Viola Lake Address of Applicant Cheverie, Hants Co., NS Date 20 July 1955

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Winnifred JaneLake

Born at Upper Nine Mile River in the County of Hants

That Winnifred JaneLake Whose Birth is sought to be registered was

born at Upper Nine Mile River Hants County on July 14, 1924

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

I am the mother of the said Winnifred Jane Lake School & Doctors record

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