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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000779

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marguerite VivianRafuse Sex Female

Date of Birth September 16, 1922 Place of Birth South WatervilleCounty of Hants

Name of Father Charles Otis Rafuse MAIDEN NAME of Mother Ethel Mary Reece

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

Residence of Father when child was born South Waterville, Hants Present address of Father Upper Vaughan, Hants

Occupation of Father at Birth of child Labourer, Lumberman Place of birth of Father South Waterville, Hants

Race Name and present address of Physician in attendance at birth

Signature of Applicant Marguerite V. Church (Rafuse) Address of Applicant RR #3, Windsor, Hants Date 27 September 1979

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marguerite VivianRafuse

Born at South Waterville in the County of Hants

That Marguerite VivianRafuse Whose Birth is sought to be registered was

born at South Waterville Hants County on September 16, 1922

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

Charles Rafuse is her father and remembers of her birth. . He is now unable to write this but can sign it as witness, Charles Otis Rafuse.

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