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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000742

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Herman St. ClairRafuse Sex Male

Date of Birth May 10, 1924 Place of Birth Martins PointCounty of Lunenburg

Name of Father Herbert Rafuse MAIDEN NAME of Mother Jennie Eisnor

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

Residence of Father when child was born Martins Point, Lunenburg Co., NS Present address of Father Deceased

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Miss. Nettie Rafuse Address of Applicant Martins Point, Lunenburg Co., NS Date 29 December 1982

Relationship of Applicant to child Friend

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Herman St. ClairRafuse

Born at Martins Point in the County of Lunenburg

That Herman St. ClairRafuse Whose Birth is sought to be registered was

born at Martins Point Lunenburg County on May 10, 1924

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

I visited the parents of Herman St. Clair Rafuse since he was two years of age and have known him ever since

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