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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000948

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Muriel ViolaGrosse Sex Female

Date of Birth April 30, 1924 Place of Birth CherrybrookCounty of Halifax

Name of Father Ernest Fairfax MAIDEN NAME of Mother Emma Grosse

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

Occupation of Father at Birth of child Place of birth of Father Dartmouth

Race Name and present address of Physician in attendance at birth

Signature of Applicant Muriel Viola Brown Address of Applicant 4289 Henri Julien Ave. Montreal, Quebec Date June 29, 1989

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Muriel ViolaGrosse

Born at Cherrybrook in the County of Halifax

That Muriel ViolaGrosse Whose Birth is sought to be registered was

born at Cherrybrook Halifax County on April 30, 1924

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

Affidavit of William Desmond; (2) Affidavit of James Elms; (3) Register of Lake Loon School. Section No. 35 District of West Halifax for school year ending July, 1934; (4) Long form marriage certificate - Province of Nova Scotia

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