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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100355

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of John FraserChisholm Sex Male

Date of Birth November 9, 1920 Place of Birth AntigonishCounty of Antigonish

Name of Father Archibald Chisholm MAIDEN NAME of Mother Mary Fraser

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

Residence of Father when child was born Antigonish Present address of Father deceased

Occupation of Father at Birth of child Carpenter Place of birth of Father Antigonish

Race Name and present address of Physician in attendance at birth

Signature of Applicant John Fraser Chisholm Address of Applicant Antigonish Date October 16, 1985

Relationship of Applicant to child child

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of John FraserChisholm

Born at Antigonish in the County of Antigonish

That John FraserChisholm Whose Birth is sought to be registered was

born at Antigonish Antigonish County on November 9, 1920

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

1. Baptism

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