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.
Nurses C: & Sir Name If the Mor. Etc. to be so Described.
Nurses Residence to be pclarised
Weekly Allowance s d
Bounty
When Paid.
What Died at Nurse, -Wher by Etc the Nurses Negligence, or how.
If Removed, When, Where, With whom & how placed.
Remarks.