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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000418

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Arnold CarlChisholm Sex Male

Date of Birth March 15, 1922 Place of Birth AmherstCounty of Cumberland

Name of Father John Chisholm MAIDEN NAME of Mother Alice Johnston

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

Residence of Father when child was born Amherst, Cumberland Present address of Father Deceased

Occupation of Father at Birth of child Case Maker Place of birth of Father Amherst, Cumberland

Race Name and present address of Physician in attendance at birth

Signature of Applicant A. C. Chisholm Address of Applicant 1194 Westerdam Road, Mississauga, Ontario Date 11 June 1971

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Arnold CarlChisholm

Born at Amherst in the County of Cumberland

That Arnold CarlChisholm Whose Birth is sought to be registered was

born at Amherst Cumberland County on March 15, 1922

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

Told by my mother, church records, school records, report cards. I have always used this as my date of birth.

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