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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99100131

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Lina DorisChiasson Sex Female

Date of Birth September 16, 1922 Place of Birth DominionCounty of Cape Breton

Name of Father Joseph John Chiasson MAIDEN NAME of Mother Elizabeth DesVeaux

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

Residence of Father when child was born Dominion No. 4, Cape Breton Present address of Father

Occupation of Father at Birth of child Place of birth of Father St. Joseph du Moine, Inverness

Race Name and present address of Physician in attendance at birth

Signature of Applicant Lina Doris Ballantyne Address of Applicant 24 Indianola Crescent, RR #2, Wasaga Beach, Ontario Date 25 March 1992

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Lina DorisChiasson

Born at Dominion in the County of Cape Breton

That Lina DorisChiasson Whose Birth is sought to be registered was

born at Dominion Cape Breton County on September 16, 1922

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

Baptism certificate Marriage extract

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