| No. in Admissions Register: | 283 |
| Date of admission: | 15 October 1864 |
| Whence received: | Birmingham Gaol |
| By whom brought: | - |
| On what terms: | - |
| Friends interested in him: | - |
| Description: | |
| Height: | - |
| Figure: | - |
| Complexion: | Fair |
| Hair colour: | Dark brown |
| Eyes colour: | Brown |
| Perfect vision? | Yes |
| State of health: | Good |
| Able-bodied? | Yes |
| Sound intellect? | Yes |
| Use of all limbs? | Yes |
| Had cow or small pox? | Cowpox |
| Particular marks: | Birthmark on right hip |
| Cutaneous disorder? | Not |
| Scrofulous or consumptive? | No |
| Subject to fits? | No |
| Age last birthday: | 12 |
| Illegitimate? | No |
| Birthday: | - |
| Birth place: | - |
| Has resided: | 5 court Ruston Street, Birmingham |
| Parish he belongs to: | Birmingham |
| Customary work and mode of life: | Filer |
| Schools attended: | - |
| By whom and where employed: | - |
| State of education: | |
| Reads: | Not at all |
| Writes: | Not at all |
| Cyphers: | - |
| General ability: | - |
| Offence: | Garden robbing |
| Circumstances which may have led to it: | Bad company |
| Date of sentence: | 26 September 1864 |
| Where convicted: | Moor Street before T Lane and G Dixon |
| Who prosecuted: | - |
| Where imprisoned: | - |
| Sentence: | 21 days hard labour, 5 years at Saltley |
| Previous committals and convictions: | None |
| Father's name: | - |
| Occupation: | - |
| Residence: | - |
| Mother's name: | Matilda Smith |
| Occupation: | None |
| Residence: | 5 court Ruston Street, Birmingham |
| Father's character: | - |
| Mother's character: | - |
| Parents dead? | Father |
| Survivor married again? | No |
| Parents' treatment of child: | Good by mother |
| Character of parents | Honest and sober but in bad health |
| Parents' wages: | Has parish relief |
| Amount parents agree to pay: | Nothing |
| Superintendent of police (to collect payments): | - |
| Relatives to communicate with: | - |
| Person making this return: | T C S Kynnersley |
| Estimate of character on admission: | - |
| Character on discharge: | - |
| When and how left the Reformatory: | - |
14 October 1869 Discharged
December 1870 In Birmingham. Doubtful [character]
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