From

Boys of the age of 12 and under the age of 13 employed below ground.

day of

18 to

day of

Name.

Age.

Residence.

Date of first Employment.

18

Remarks.

16

Male young persons of the age of 13 and under the age of 16 employed below ground.

day of

18

to

Name.

Agc.

Residence.

18

Remarks.

17

From

Boys of the age of 8 and under the age of 13 employed above ground.

day of

18 to

day of

Name.

Age.

Residence.

Date of first Employment.

18

Remarks.

18

From

Male young persons of the age of 13 and under the age of 18 employed above ground.

day of

18

to

Name.

Age.

Residence.