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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100053

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mildred JosephineGrosse Sex Female

Date of Birth April 15, 1921 Place of Birth Cherry BrookCounty of Halifax

Name of Father   MAIDEN NAME of Mother Anna Maria Grosse

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 Mildred Josephine Cromwell Address of Applicant 345 Hickory St. Collingwood, Ontario Date June 1984

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mildred JosephineGrosse

Born at Cherry Brook in the County of Halifax

That Mildred JosephineGrosse Whose Birth is sought to be registered was

born at Cherry Brook Halifax County on April 15, 1921

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

Mother - Ann Marie Grosse; Grandmother - Mary Elizabeth Grosse, Grandfather - James Ozzie Grosse; Brothers - Kenneth George; Raymond Saint Clair; Charles Edward, Sister - Arcola May

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