§

1788 1788

Name of the Child
If a Foundling mark F.
If a BastardB.
If a CasualtyC.
If the same Child is
taken a second time
mark the second Entry
of the Name2.
If a third time3
Etc

Age
Real or
reputed
Years Y
Months M
Days D

If Born
in the
Workhouse
when

If not
Born
in the
Workhouse
when
admitted

Name of the
Person by whom
sent. If by
an Officer mark
the Name C.
If by the Father F.
If by the Mother M

If
Money
be received
with any
Child
what Sum

When
Died in
the
Workhouse

When discharged
from the
Workhouse
If Nursed by
the Mother
mark M

If removed
or passed
to what place

When delivered from
the Workhouse to
the Father, Mother
or other Person
If to the Father mark F.
If to the Mother M
If to any other Person
mention his or her
Name

Nurses Name to whom
delivered to be Nursed.
If a Wet Nurse markW
If a dry NurseD.
If the Nurse dies or
is charged write
the Name of the new
Nurse under the
Former

Place
where
the
Nurse
lives

Price of Nursing each Week

Bounty
to
Nurses

If died
at Nurse
when

If taken from
Nurse when.
If brought to the
Workhouse mark W.
If delivered to the
Mother mark M.
If to the Father F.
If to any others
Person mention
his or her Name

Y M D
Willm. Francis< no role > C.
1788 28. July
1788 19. Augt.
4s

John Dod< no role >
Thos Lancaster< no role > }
Church Wardens

Thos Hudson< no role >
Henry Rutt< no role > }
Overseers

Nl: Andrews< no role >
Vestry Cl

Duplicate signd by Mr Phillips Master of the Workhouse

4th. Feb. 1789 deled Duplicate to Mr. Crippen NA