| No. in Admissions Register: | 536 |
| Age: | 15 |
| Whence received: | Stafford |
| Description: | |
| Complexion: | - |
| Hair colour: | Brown |
| Eyes colour: | Brown |
| Visage: | - |
| Particular marks: | - |
| State of health: | Good |
| Able-bodied? | Yes |
| Date of admission and term: | 30 June 1875 (delayed until 2 July) 3 years |
| Late residence: | Newcastle, Staffordshire |
| Parish he belongs to: | Stoke on Trent |
| Customary work and mode of life: | Farm work |
| Whether illegitimate: | - |
| State of education: | |
| Reads: | Not at all |
| Writes: | Not at all |
| Offence: | Stealing beer |
| Circumstances which may have led to it: | - |
| Date of sentence, by who and court: | 30 May 1875, Hanley Police Court, H C Greenwood |
| Where imprisoned: | Stafford |
| Sentence: | 1 month prison (hard labour), 3 years at Saltley |
| Previous committals: | |
| Number: | One |
| Length: | 1 month |
| For what: | Stealing a watch |
| Father's name: | - |
| Occupation: | - |
| Mother's name: | Mary Jones |
| Occupation: | - |
| Parents dead? | Father |
| Survivor married again? | - |
| Parents' treatment of child: | - |
| Character of parents | Good |
| Parents' wages: | Mother in workhouse |
| Amount parents agree to pay: | - |
| Parents address: | Stoke workhouse |
| Superintendent of police (to collect payments): | - |
| Person making this return: | - |
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