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