Childrens Names Wher. Legitimate or Illegitimate.
When Admitted or Born in the House.
Age when Admitted Y:M:D
Mothers Name Settlemt. & Residence.
Fathers Name Settlemt. Residence & Occupation
When Placed out to Nurse
Nurses C: & Sir Name If the Mor. Etc to be or Described.
Nurses Residence to be ptlicularised.
Weekly Allowance s d
Bounty
When Paid
When Died at Nurse, Wher, Etc by the Negligence of the Nurse, or how.
If Removed, When, Where, With whom, & how Placed.
Remarks