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Childrens Names Wher. Legitimate or Illegitimate
When Admitted or Born in the House, If not Admitted, Note it.
Age when Admitted Y: M: D
Mothers Name Settlemt. & Residence.
Fathers Name Settlemt. Residence & Occupation
When Placed out to Nurse
Nurse C:& Sir Name If the Mor. or other, Relation to be so Described
Nurses Residence be Particularised
Weekly Allowance s d
Bounty
When Paid
When Died at Nurse, Wher. supposed to be Occasioned by the Nurses Negligence, or how
If Removed, When, where, with whom & how Placed.
Remarks