Page:UKSRO 1899 (Part II).pdf/966

This page needs to be proofread.
1842


Questions. Answers of Applicant. Inspector's Remarks. (Parish of Chargeability.). Inspector's Remarks. (Parish of Residence.)

1. Present residence?

2. Age?

3. Whether single or married?

4. Number of children or dependants (if any) living in family?

5. Names and ages of such children or dependants ?


6. Employment and earnings of such children or dependants?

7. If parent alive, and in what circumstances?

8. Names, employment, and earnings of children not living in family?

9. Present occupation of Applicant?

10. Occupation previous to first receiving relief?

11. How long has Parochial Relief been received?

12. Amount of present in Parochial Relief money, clothing, or of any other kind?

13. Whether wholly or partially disabled, and from what cause?

14. Does Applicant pay any, and what, rent for house or room now occupied?

This article is issued from Wikisource. The text is available under Creative Commons Attribution-Share Alike 4.0 unless otherwise noted. Additional terms may apply for the media files.