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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000678

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Marion MyrtleCrouse Sex Female

Date of Birth July 22, 1923 Place of Birth South BrookfieldCounty of Queens

Name of Father Archibald Hardy Crouse MAIDEN NAME of Mother Lulu Mae Hirtle

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

Residence of Father when child was born South Brookfield Queens Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father Niniveh, Lunenburg Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Marion Myrtle Crouse Address of Applicant Springfield, Annapolis Co., NS Date 1 September 1978

Relationship of Applicant to child Same person

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Marion MyrtleCrouse

Born at South Brookfield in the County of Queens

That Marion MyrtleCrouse Whose Birth is sought to be registered was

born at South Brookfield Queens County on July 22, 1923

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

Certificate of baptism Certificate of marriage

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