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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000406

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Burnal LawsonRafuse Sex

Date of Birth September 6, 1920 Place of Birth BridgewaterCounty of Lunenburg

Name of Father Joshua Rafuse MAIDEN NAME of Mother Meadie Penney

Were the Parents married at the time of the Birth?

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

Occupation of Father at Birth of child Laborer Place of birth of Father Bridgewater

Race English Name and present address of Physician in attendance at birth Dr. F.R. Davis, Deceased

Signature of Applicant C.H. Whitteker Address of Applicant Bridgewater Date January 8, 1965

Relationship of Applicant to child None

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Burnal LawsonRafuse

Born at Bridgewater in the County of Lunenburg

That Burnal LawsonRafuse Whose Birth is sought to be registered was

born at Bridgewater Lunenburg County on September 6, 1920

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

Certification of his age when beginning school - enclosed. Record of age at time of marriage from provincial records.

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