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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000109

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Bernard JosephChisholm Sex Male

Date of Birth October 31, 1924 Place of Birth Margaree ForksCounty of Inverness

Name of Father Thomas Chisholm MAIDEN NAME of Mother Jessie Coady

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

Residence of Father when child was born Margaree Forks, Inverness Co., NS Present address of Father Deceased

Occupation of Father at Birth of child Creamery Manager Place of birth of Father Antigonish, NS

Race Name and present address of Physician in attendance at birth

Signature of Applicant Mrs. Jessie Chisholm Address of Applicant North East Margaree Forks, Inverness Co., NS Date 31 May 1951

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Bernard JosephChisholm

Born at Margaree Forks in the County of Inverness

That Bernard JosephChisholm Whose Birth is sought to be registered was

born at Margaree Forks Inverness County on October 31, 1924

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

Birth certificate already in your possession (attached)

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