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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000931

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

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

Date of Birth April 25, 1923 Place of Birth Caledonia MillsCounty of Antigonish

Name of Father Angus A. Chisholm MAIDEN NAME of Mother Mary Ann MacDonald

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

Residence of Father when child was born Caledonia Mills Antigonish Co Ns Present address of Father Deceased

Occupation of Father at Birth of child Farmer Place of birth of Father

Race Name and present address of Physician in attendance at birth

Signature of Applicant John B. Chisholm Address of Applicant Caledonia Mills, Antigonish Co, NS Date 23 August 1985

Relationship of Applicant to child Self

AFFIDAVIT

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

Born at Caledonia Mills in the County of Antigonish

That John BernardChisholm Whose Birth is sought to be registered was

born at Caledonia Mills Antigonish County on April 25, 1923

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

I was advised by my parents of the date of my birth

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