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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000505

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Clara IsabelChisholm Sex Female

Date of Birth January 18, 1923 Place of Birth Brierly BrookCounty of Antigonish

Name of Father Valentine Chisholm MAIDEN NAME of Mother Margaret MacDonald

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

Residence of Father when child was born Brierly Brook Antigonish Co. Ns Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father Brierly Brook, Antigonish Co., NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Clara Isabel Bethune Address of Applicant 10 Vanier Drive Date 6 January 1975

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Clara IsabelChisholm

Born at Brierly Brook in the County of Antigonish

That Clara IsabelChisholm Whose Birth is sought to be registered was

born at Brierly Brook Antigonish County on January 18, 1923

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

My birthday has been celebrated on January 19, in each year for all years since earliest recollection, and my birth date has been indicated to me as having been January 18, 1923 since early childhood and recollection.

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