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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000243

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Randolph AutreyCrouse Sex Male

Date of Birth May 8, 1924 Place of Birth East CliffordCounty of Lunenburg

Name of Father Howard Harty Crouse MAIDEN NAME of Mother Olive Wile

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

Residence of Father when child was born East Clifford Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father East Clifford

Race Name and present address of Physician in attendance at birth

Signature of Applicant Olive Crouse Address of Applicant Nictaux West, Annapolis Co. NS Date 11 December 1961

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Randolph AutreyCrouse

Born at East Clifford in the County of Lunenburg

That Randolph AutreyCrouse Whose Birth is sought to be registered was

born at East Clifford Lunenburg County on May 8, 1924

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

National registration and school records. I, Olive Crouse, gave birth to a son, May 8, 1924 at East Clifford, Lunenburg County. Mrs. Ida Crouse, deceased, those that were in attendance. Dr. Fraser, deceased.

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