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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000394

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bessie BlancheCrocker Sex Female

Date of Birth March 28, 1922 Place of Birth WatervilleCounty of Kings

Name of Father Kempton Dudley crocker MAIDEN NAME of Mother Francis Ethel Mahar

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

Residence of Father when child was born Waterville, Kings Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant Bessie Blanche Crocker Address of Applicant 67 Marjory Avenue, Toronto, Ontario Date 11 April 1969

Relationship of Applicant to child Myself

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bessie BlancheCrocker

Born at Waterville in the County of Kings

That Bessie BlancheCrocker Whose Birth is sought to be registered was

born at Waterville Kings County on March 28, 1922

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

Judging by the data entered in the leaf of Summary of Attendance for term ending July 1934, page 17, Public School "Fairview" and registered under No. 8.

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