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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.
Nurses C: & Sir Name
Nurses Residence to be plarised.
Weekly Allowance S D
Bounty
When Paid.
When Died at Nurse, - Wher. Etc by the Nurses Negligence, or how.
If Removed, When, Where, With whom, & how Placed
Remarks