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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

90501330

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Jean ElizabethChisholm Sex Female

Date of Birth January 25, 1920 Place of Birth StellartonCounty of Pictou

Name of Father Roderick Chisholm MAIDEN NAME of Mother Elizabeth Bell McDonald

Residence of Father when child was born Stellarton, Pictou Co. Present address of Father Stellarton, Pictou Co.

Occupation of Father at Birth of child Tramway Employee Place of birth of Father Blue Mountain, Pictou Co.

Race Canadian Name and present address of Physician in attendance at birth Dr. Clarence Miller, New Glasgow

Signature of Applicant Roderick Chisholm Address of Applicant Stellarton, Pictou Co. Date 23 September 1939

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Jean ElizabethChisholm

Born at Stellarton in the County of Pictou

That Jean ElizabethChisholm Whose Birth is sought to be registered was

born at Stellarton Pictou County on January 25, 1920

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

As father, I have personal knowledge of the date of birth having been at home the day she was born.

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