| Schedule | Surnames and Other Names | O,V,S,P, or L | M or F | Birth | S,M,W, or D | Personal | See Instructions |
| 115/1 | Hollis, John A | Male | 24 Mar 1866 | Married | Blacksmith Retired OAP | ||
| 115/2 | Hollis, Amelia | Female | 25 May 1867 | Married | unpaid d. d. OAP |
Source: findmypast - 1939 Register RG101/1762D/011/20