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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

64500033

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Everett JohnsonHollis Sex Male

Date of Birth October 20, 1919 Place of Birth LeicesterCounty of Cumberland

Name of Father Richard Arthus Hollis MAIDEN NAME of Mother Augusta Leona Wood

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

Residence of Father when child was born Leicester Present address of Father

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

Race Name and present address of Physician in attendance at birth Dr. Goodwin

Signature of Applicant Richard Arthur Hollis Address of Applicant Leicester Date 10 January 1920

Relationship of Applicant to child father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Everett JohnsonHollis

Born at Leicester in the County of Cumberland

That Everett JohnsonHollis Whose Birth is sought to be registered was

born at Leicester Cumberland County on October 20, 1919

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

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