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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000671

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John WilliamCrosby Sex Male

Date of Birth February 6, 1921 Place of Birth HalifaxCounty of Halifax

Name of Father William Henry Crosby MAIDEN NAME of Mother Minnie Ryan

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

Residence of Father when child was born Halifax Present address of Father deceased

Occupation of Father at Birth of child Dominion Coal Company Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant John William Crosby Address of Applicant 6401 Summit St. Halifax Date March 8, 1977

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John WilliamCrosby

Born at Halifax in the County of Halifax

That John WilliamCrosby Whose Birth is sought to be registered was

born at Halifax Halifax County on February 6, 1921

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

Baptismal Certificate Marriage Extract

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