§

1768 1768

Name of the Child
If a Foundling mark F
If a BastardB
If a Casually C
If the same Child is
taken a second time
mark the second Entry
of the Name2.
If a Third3
Etc.

Age
Real or
Reputed
Years Y
Months M
Days D

If Born
in the
Work house
when

If not Born
in the
Work house
when
admitted

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

If Money
be received
with any
Child
What Sum

When died
in the
Work house

When discharged
from the
Work house
If nursed by
the Mother Mark
M

If Removed or
Passed to what
Place

When delivered from
the Work house 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.

Nurse's Name to
whom delivered to be
Nursed. If a wet Nurse
markW
If a dry Nurse. D
If the Nurse dies or
is changed 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 other Person
mention his or her
Name.

This is to Certify that there has not been one Poor Infant under
four Years of Age belonging to and maintained by the said Parish
of St. Dionis Backchurch from the 1st. day of January to the 31st day
of December. 1768. Witness our hands this 28th. day of January 17 [..]

Thos Shellam< no role >
Jo Chaplin Hankey< no role > }
Church Wardens

Peter Pope< no role >
Hong. Newton< no role >
William Lem< no role > }
Overseers of the Poor .

N Andrews
Vestry Clerk

The Duplicate is
Signd also by Mrs Phillip
Master of the Workhouse
and delivered to Mr. C [..]
Agent for the Compy
Parish Clerks 4th. Feby