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<p n="136">§</p>
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<p n="137">Childrens Names Wher Legitimate or Illegitimate <lb></lb>
When Admitted or Born in the House If not Admitted, Note it. <lb></lb>
Age when Admitted Y: M: D <lb></lb>
Mors Name Settlemt & Residence <lb></lb>
Fathers Name Settlemt. Residence & Occupation <lb></lb>
When Placed out to Nurse <lb></lb>
Nurses C:& Sir Name If the Mor. or other, Relation to be so ment <lb></lb>
Nurses Residence<obscured></obscured>
Particularised <lb></lb>
Weekly Allowance S:D <lb></lb>
Bounty <lb></lb>
When Paid <lb></lb>
When Died at Nurse, Wher Supposed to be Occasioned by the Nurses Negligence, or how <lb></lb>
If Removed, When, where, with whom & how Placed. <lb></lb>
Remarks</p>
<p n="138">Casualty Man</p>
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