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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000648

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ralph EdwardRafuse Sex Male

Date of Birth May 23, 1920 Place of Birth MiltonCounty of Queens

Name of Father Harvey Rafuse MAIDEN NAME of Mother Edith MacLeod

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

Residence of Father when child was born Milton Present address of Father Dead

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

Race White Name and present address of Physician in attendance at birth Dr. Hennigar, dead

Signature of Applicant Annabel Marie Rafuse Address of Applicant Liverpool Date August 17, 1973

Relationship of Applicant to child wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ralph EdwardRafuse

Born at Milton in the County of Queens

That Ralph EdwardRafuse Whose Birth is sought to be registered was

born at Milton Queens County on May 23, 1920

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

Certificate of Baptism attached

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