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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000929

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Douglas HarveyCroft Sex Male

Date of Birth August 28, 1921 Place of Birth West LiscombCounty of Guysborough

Name of Father Jacob Emery Croft MAIDEN NAME of Mother Jane Myria  MacDonald

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

Residence of Father when child was born West Liscomb Present address of Father deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Nellie Schrider Address of Applicant 2327 Brunswick St. Halifax Date June 24, 1981

Relationship of Applicant to child Sister

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Douglas HarveyCroft

Born at West Liscomb in the County of Guysborough

That Douglas HarveyCroft Whose Birth is sought to be registered was

born at West Liscomb Guysborough County on August 28, 1921

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

National Registration Census

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