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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000651

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Madeline Eva JoanCrook Sex Female

Date of Birth April 19, 1924 Place of Birth DartmouthCounty of Halifax

Name of Father Russell Crook MAIDEN NAME of Mother Bessie Phillips

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

Residence of Father when child was born Dartmouth, NS Present address of Father Deceased

Occupation of Father at Birth of child Accountant Place of birth of Father Lawrencetown, Halifax Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Madeline J. Rousselle Address of Applicant 251 William Street, Renfrew, Ontario Date 15 October 1979

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Madeline Eva JoanCrook

Born at Dartmouth in the County of Halifax

That Madeline Eva JoanCrook Whose Birth is sought to be registered was

born at Dartmouth Halifax County on April 19, 1924

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

Baptismal

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