| No. in Admissions Register: | 222 |
| Date of admission: | 2 July 1861 |
| Whence received: | Stafford |
| By whom brought: | - |
| On what terms: | - |
| Friends interested in him: | - |
| Description: | |
| Height: | - |
| Figure: | - |
| Complexion: | Sallow |
| Hair colour: | Light brown |
| Eyes colour: | Grey |
| Perfect vision? | Yes |
| State of health: | Good |
| Able-bodied? | Quite |
| Sound intellect? | Yes |
| Use of all limbs? | Yes |
| Had cow or small pox? | Vaccinated |
| Particular marks: | Mole on chin and cut on right arm |
| Cutaneous disorder? | No |
| Scrofulous or consumptive? | No |
| Subject to fits? | No |
| Age last birthday: | 12 |
| Illegitimate? | No |
| Birthday: | - |
| Birth place: | - |
| Has resided: | Willenhall |
| Parish he belongs to: | Wolverhampton |
| Customary work and mode of life: | Caster in iron works |
| Schools attended: | - |
| By whom and where employed: | - |
| State of education: | |
| Reads: | Not at all |
| Writes: | Not at all |
| Cyphers: | - |
| General ability: | - |
| Offence: | Stealing a pigeon |
| Circumstances which may have led to it: | - |
| Date of sentence: | 19 June 1861 |
| Where convicted: | Wolverhampton, W Partridge, Stipendiary Magistrate |
| Who prosecuted: | - |
| Where imprisoned: | - |
| Sentence: | 14 days prison, 5 years at Saltley |
| Previous committals and convictions: | None |
| Father's name: | David Faulkner |
| Occupation: | Locksmith |
| Residence: | Church Street, Willenhall |
| Mother's name: | Caroline Faulkner |
| Occupation: | - |
| Residence: | Church Street, Willenhall |
| Father's character: | - |
| Mother's character: | - |
| Parents dead? | - |
| Survivor married again? | - |
| Parents' treatment of child: | Good |
| Character of parents | - |
| Parents' wages: | 18s per week by father, when in work |
| Amount parents agree to pay: | Ordered to pay 1s per week |
| Superintendent of police (to collect payments): | Edward Thompson, Willenhall |
| Relatives to communicate with: | - |
| Person making this return: | J S Ward, Wolverhampton |
| Estimate of character on admission: | - |
| Character on discharge: | - |
| When and how left the Reformatory: | - |
8 January 1865 Licensed
26 December 1866 Called at the school. Well dressed and evidently doing well as a working man
October 1867 Called at the school. Well dressed and evidently doing well as a working man
December 1868 Doing well
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