| No. in Admissions Register: | 335 |
| Date of admission: | 1 June 1866 |
| Whence received: | Stafford |
| By whom brought: | - |
| On what terms: | - |
| Friends interested in him: | - |
| Description: | |
| Height: | - |
| Figure: | - |
| Complexion: | - |
| Hair colour: | - |
| Eyes colour: | - |
| Perfect vision? | - |
| State of health: | Good |
| Able-bodied? | Yes |
| Sound intellect? | - |
| Use of all limbs? | - |
| Had cow or small pox? | - |
| Particular marks: | None |
| Cutaneous disorder? | - |
| Scrofulous or consumptive? | - |
| Subject to fits? | - |
| Age last birthday: | 15 |
| Illegitimate? | - |
| Birthday: | - |
| Birth place: | - |
| Has resided: | Hanley |
| Parish he belongs to: | Stoke on Trent |
| Customary work and mode of life: | Potting |
| Schools attended: | - |
| By whom and where employed: | - |
| State of education: | |
| Reads: | Not at all |
| Writes: | Not at all |
| Cyphers: | - |
| General ability: | - |
| Offence: | Stealing 3s |
| Circumstances which may have led to it: | Bad company |
| Date of sentence: | 11 May 1866 |
| Where convicted: | Stoke on Trent |
| Who prosecuted: | - |
| Where imprisoned: | - |
| Sentence: | 21 days' prison (hard labour), 4 years at Saltley |
| Previous committals and convictions: | Larceny (1 month) |
| Father's name: | - |
| Occupation: | - |
| Residence: | - |
| Mother's name: | Ann Salt |
| Occupation: | Prostitute |
| Residence: | Old Hall Street, Hanley |
| Father's character: | - |
| Mother's character: | Drunken and bad |
| Parents dead? | - |
| Survivor married again? | - |
| Parents' treatment of child: | Harsh |
| Character of parents | - |
| Parents' wages: | - |
| Amount parents agree to pay: | Not deemed able to pay |
| Superintendent of police (to collect payments): | - |
| Relatives to communicate with: | - |
| Person making this return: | - |
| Estimate of character on admission: | - |
| Character on discharge: | - |
| When and how left the Reformatory: | - |
24 August 1869 Licensed
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