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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000273

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Mary AnnChisholm Sex

Date of Birth June 26, 1920 Place of Birth Port HawkesburyCounty of Inverness

Name of Father Alexander C. Chisholm MAIDEN NAME of Mother Mary Jane MacDonald

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

Residence of Father when child was born Port Hawkesbury Present address of Father deceased

Occupation of Father at Birth of child Merchant Place of birth of Father Glendale

Race Scottish Name and present address of Physician in attendance at birth J.R. MacLeod, M.D. (Deceased)

Signature of Applicant Mary Ann Chisholm Address of Applicant 72 South Street, Halifax Date April 26, 1957

Relationship of Applicant to child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Mary AnnChisholm

Born at Port Hawkesbury in the County of Inverness

That Mary AnnChisholm Whose Birth is sought to be registered was

born at Port Hawkesbury Inverness County on June 26, 1920

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

Certificate of Baptism.

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