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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000328

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Martha MaryCrook Sex Female

Date of Birth May 31, 1923 Place of Birth ThorburnCounty of Pictou

Name of Father Seymour Crook MAIDEN NAME of Mother Catherine Theresa Duvtic

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

Residence of Father when child was born McLellan Mountain Pictou Co. Ns Present address of Father Thorburn, Pictou Co., NS

Occupation of Father at Birth of child Miner and Farmer Place of birth of Father Westhoughton, Lancashire, England

Race Name and present address of Physician in attendance at birth

Signature of Applicant Martha Mary Crook Address of Applicant Red Rock, Ontario Date 23 February 1967

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Martha MaryCrook

Born at Thorburn in the County of Pictou

That Martha MaryCrook Whose Birth is sought to be registered was

born at Thorburn Pictou County on May 31, 1923

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

I am the father of the applicant and as such have personal knowledge of her birth.

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