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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000697

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Chesley BrentonO'Brien Sex Male

Date of Birth April 8, 1924 Place of Birth LondonderryCounty of Colchester

Name of Father Peter O'Brien MAIDEN NAME of Mother Jessie Rushton

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

Residence of Father when child was born Londonderry, Colchester Co., NS Present address of Father Londonderry, Colchester Co., NS

Occupation of Father at Birth of child Place of birth of Father Londonderry, Colchester Co., NSCounty

Race Name and present address of Physician in attendance at birth

Signature of Applicant Jessie O'Brien Address of Applicant Londonderry, Colchester Co., NS Date 29 November 1980

Relationship of Applicant to child Mother

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Chesley BrentonO'Brien

Born at Londonderry in the County of Colchester

That Chesley BrentonO'Brien Whose Birth is sought to be registered was

born at Londonderry Colchester County on April 8, 1924

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

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