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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000025

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth January 4, 1921 Place of Birth Whites CornerCounty of Kings

Name of Father Clyde Ronald Rafuse MAIDEN NAME of Mother Minnie Alberta Gould

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

Residence of Father when child was born Whites Corner Present address of Father Windsor

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

Race Canadian Name and present address of Physician in attendance at birth Dr. Killam

Signature of Applicant Mrs. Minnie Rafuse Address of Applicant Windsor Date September 24, 1946

Relationship of Applicant to child Mother

AFFIDAVIT

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

Born at Whites Corner in the County of Kings

That Seymour EdwardRafuse Whose Birth is sought to be registered was

born at Whites Corner Kings County on January 4, 1921

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

I am his mother and Dr. Killam was in attendance at birth.

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