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 Ptlarised
Weekly Allowance s:d
Bounty
When Paid
When Died at Nurse Wher. Occassioned by the Nurse's Negligence, or how.
If Removed When, Where, with whom & how Placed.
Remarks