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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

91400356

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of William SheradCrowell Sex Male

Date of Birth October 30, 1920 Place of Birth LiverpoolCounty of Queens

Name of Father Ashton L. Crowell MAIDEN NAME of Mother Jessie B. Winters

Residence of Father when child was born Barrington, Queens Co. Present address of Father Barrington, Queens Co.

Occupation of Father at Birth of child Painter Place of birth of Father Barrington, Queens Co.

Race English Name and present address of Physician in attendance at birth Dr. Ford, Liverpool, Queens Co.

Signature of Applicant Ashton L. Crowell Address of Applicant Barrington, Queens Co. Date 31 October 1940

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of William SheradCrowell

Born at Liverpool in the County of Queens

That William SheradCrowell Whose Birth is sought to be registered was

born at Liverpool Queens County on October 30, 1920

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

The fact and date of such birth based upon his baptismal record

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