| No. in Admissions Register: | 361 |
| Date of admission: | 27 August 1867 |
| Whence received: | Stafford Gaol |
| By whom brought: | - |
| On what terms: | - |
| Friends interested in him: | - |
| Description: | |
| Height: | - |
| Figure: | - |
| Complexion: | Sallow |
| Hair colour: | Brown |
| Eyes colour: | Grey |
| Perfect vision? | - |
| State of health: | Good |
| Able-bodied? | Yes |
| Sound intellect? | - |
| Use of all limbs? | - |
| Had cow or small pox? | - |
| Particular marks: | - |
| Cutaneous disorder? | - |
| Scrofulous or consumptive? | - |
| Subject to fits? | - |
| Age last birthday: | 14 |
| Illegitimate? | No |
| Birthday: | - |
| Birth place: | - |
| Has resided: | West Bromwich |
| Parish he belongs to: | Pelsall |
| Customary work and mode of life: | Working in a forge |
| Schools attended: | - |
| By whom and where employed: | - |
| State of education: | |
| Reads: | Imperfectly |
| Writes: | Imperfectly |
| Cyphers: | - |
| General ability: | - |
| Offence: | Stealing 13s |
| Circumstances which may have led to it: | - |
| Date of sentence: | 17 July 1867 |
| Where convicted: | West Bromwich |
| Who prosecuted: | - |
| Where imprisoned: | - |
| Sentence: | 1 month prison, 4 years at Saltley |
| Previous committals and convictions: | Stealing money (7 days) |
| Father's name: | - |
| Occupation: | - |
| Residence: | - |
| Mother's name: | Ann Haslam |
| Occupation: | None |
| Residence: | Golds Green, West Bromwich |
| Father's character: | - |
| Mother's character: | - |
| Parents dead? | Father |
| Survivor married again? | Not |
| Parents' treatment of child: | Good |
| Character of parents | Honest and sober. Health not good |
| Parents' wages: | None - pauper |
| Amount parents agree to pay: | None |
| 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: | - |
23 August 1869 Absconded
26 August 1869 Fetched back from Burton on Trent
28 August 1869 There is a short report about the return in the Staffordshire Advertiser Saturday 28 August 1869 p.7 col.3: DESERTERS.- Mark Comery, of Castle Gresley (committed by the Burton Bench for stealing spirits belonging to his master, about twelve months ago), and John Haslam, 16, of Gould's Green, West Bromwich. were brought up as runaways from the Saltley Reformatory. They escaped on Monday, came to Burton, and gave themselves up to the police this morning. They were ordered to be taken back to the Reformatory.
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