| Date of Birth | 13th July 1903 |
| Place of Birth | Victoria |
| Sex of Child | Male |
| Name of Child | John |
| Name and Surname of Father | Russell Richard Hollis |
| Name and Maiden Surname of Mother | Gertrude Mary Hicks |
| Residence and Rank or Profession of Father | inbetween? Bricklayer |
| Name of Medical Attendant or Accoucheur and Nurse | Wm Pollard/Nurses |
| Reason Father of child does not report the birth |
DATED at Victoria B.C. this 31st. day of August
(Signature of Informant) Russell R. Hollis
Address in full of Informant) 4 Broughton S E, Victoria, B.C.
Source: Royal BC Museum