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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000364

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Michael DunstonChisholm Sex Male

Date of Birth August 13, 1923 Place of Birth FlorenceCounty of Cape Breton

Name of Father Joseph Chisholm MAIDEN NAME of Mother Mary Ann Murphy

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

Residence of Father when child was born Florence Cape Breton Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Labourer Place of birth of Father Mill Creek, Cape Breton Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant M. D. Chisholm Address of Applicant Florence, Cape Breton Co., NS Date October 1969

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Michael DunstonChisholm

Born at Florence in the County of Cape Breton

That Michael DunstonChisholm Whose Birth is sought to be registered was

born at Florence Cape Breton County on August 13, 1923

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

That to the best of my knowledge, information and belief, I was born in Florence, Cape Breton, Nova Scotia on the 13 day of August 1923.

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