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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100078

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of St. Clair KemptonCrouse Sex Male

Date of Birth October 6, 1920 Place of Birth ChelseaCounty of Lunenburg

Name of Father   MAIDEN NAME of Mother Addie Bell Crouse

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Althea Crouse Address of Applicant Charleston, Queens Co. Date 22 August 1980

Relationship of Applicant to child Wife

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of St. Clair KemptonCrouse

Born at Chelsea in the County of Lunenburg

That St. Clair KemptonCrouse Whose Birth is sought to be registered was

born at Chelsea Lunenburg County on October 6, 1920

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

A declaration dated 1928, a census and a school record

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