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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000898

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Roseville AdnahMulock Sex Male

Date of Birth April 14, 1920 Place of Birth Rhodes CornerCounty of Lunenburg

Name of Father Adnah Nathanial  Mulock MAIDEN NAME of Mother Hildred Gertrude Crouse

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

Residence of Father when child was born Rhodes Corner Present address of Father deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Rhodes Corner

Race Name and present address of Physician in attendance at birth

Signature of Applicant Roseville Adnah Mulock Address of Applicant Date March 18, 1978

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Roseville AdnahMulock

Born at Rhodes Corner in the County of Lunenburg

That Roseville AdnahMulock Whose Birth is sought to be registered was

born at Rhodes Corner Lunenburg County on April 14, 1920

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

Baptismal Certificate and Family Knowledge

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