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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000766

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Colin SewardChisholme Sex Male

Date of Birth June 11, 1920 Place of Birth MulgraveCounty of Guysborough

Name of Father William 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 Mulgrave Present address of Father deceased

Occupation of Father at Birth of child Engineer, Canadian National Railway Place of birth of Father Briley Brook

Race Name and present address of Physician in attendance at birth

Signature of Applicant Colin S. Chisholm Address of Applicant Chelsea, Quebec Date January 12, 1976

Relationship of Applicant to child self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Colin SewardChisholme

Born at Mulgrave in the County of Guysborough

That Colin SewardChisholme Whose Birth is sought to be registered was

born at Mulgrave Guysborough County on June 11, 1920

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

Baptism

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