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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

92000798

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Irene HarriettHolland Sex Female

Date of Birth December 13, 1921 Place of Birth Glace BayCounty of Cape Breton

Name of Father John Holland MAIDEN NAME of Mother Mary Hannah Barnes

Residence of Father when child was born No. 3 Mine, Glace Bay, Cape Breton Co., NS Present address of Father Barnesboro, Pennsylvania, USA

Occupation of Father at Birth of child Miner Place of birth of Father Carlisle, England

Race Name and present address of Physician in attendance at birth

Signature of Applicant John Holland Address of Applicant Barnesboro, Pennsylvania, USA Date 19 March 1942

Relationship of Applicant to child Father

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Irene HarriettHolland

Born at Glace Bay in the County of Cape Breton

That Irene HarriettHolland Whose Birth is sought to be registered was

born at Glace Bay Cape Breton County on December 13, 1921

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

That I am her father and know for a fact beyond doubt that she was born on the month date and year and place as stated above.

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