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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000444

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Evelyn M.Crouse Sex Female

Date of Birth October 27, 1924 Place of Birth South BrookfieldCounty of Queens

Name of Father Archie Crouse MAIDEN NAME of Mother Lulu 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 Labourer Place of birth of Father East Clifford, Lunenburg Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Evelyn M. Smith Address of Applicant RR #4, New Germany, Lunenburg Co., NS Date 7 January 1975

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Evelyn M.Crouse

Born at South Brookfield in the County of Queens

That Evelyn M.Crouse Whose Birth is sought to be registered was

born at South Brookfield Queens County on October 27, 1924

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

Copy of census records - June 1, 1931, "Evelyn Crouse" 6 years of age, born in the Province of Nova Scotia living with "Archie and Lulu Crouse" in the polling district of Brookfield, June 1, 1941 "Evelyn Crouse" 16 years of age. Born in the Province of Nova Scotia in the polling district of Hemford. Also small book of common prayer entry in back cover reads Evelyn M. born October 27 1924

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