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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000548

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of ChesterMcLaughlin Sex Male

Date of Birth January 21, 1924 Place of Birth Mill VillageCounty of Queens

Name of Father   MAIDEN NAME of Mother Sadie McLaughlin

Were the Parents married at the time of the Birth? No

Residence of Father when child was born Present address of Father

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

Race Name and present address of Physician in attendance at birth

Signature of Applicant Chester McLaughlin Address of Applicant Liverpool, Queens Co., NS Date September 1977

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of ChesterMcLaughlin

Born at Mill Village in the County of Queens

That ChesterMcLaughlin Whose Birth is sought to be registered was

born at Mill Village Queens County on January 21, 1924

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

I am an illegitimate child, my mother is dead. I do not know who my father was. There is no one else to make this affidavit. A court finding has been made under Section 7 of the Vital Statistics Act, giving me the above birth date and filed into you.

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