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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000013

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Willard Parker CrocksonClayton Sex Male

Date of Birth August 2, 1921 Place of Birth LiverpoolCounty of Queens

Name of Father   MAIDEN NAME of Mother Idella May Crockson

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 Negro Name and present address of Physician in attendance at birth Isobel Wesley midwife

Signature of Applicant Idella May Clayton Address of Applicant Hammonds Plains Date September 5, 1946

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Willard Parker CrocksonClayton

Born at Liverpool in the County of Queens

That Willard Parker CrocksonClayton Whose Birth is sought to be registered was

born at Liverpool Queens County on August 2, 1921

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

That I am the Mother of Willard Parker Crockson (Clayton) and that he was born at Liverpool on August 2, 1921 also he was born out of wedlock and has been known for the past twenty years as William Parker Crockson Clayton, the name of his foster father Samuel J. Clayton.

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