| Name and Surname | Relationship | Age - Years & Months | Marriage or Orphanhood | Birthplace | Nationality | Education | Occupation | Employment | Place of Work | Number & Ages of Living Children under 16 |
| Elizabeth H.A. Reeve | 71 - 6 | Widow | Norfolk Downham Market | Britihs | Home Duties | none | ||||
| John Henry Grounds | Brother | 64 - 6 | Widower | Norfolk Hethersett [sic] | British | Carrage [sic] Painter | J. Ringer? Carrage [sic] Builder out of work |
This form was originally filled out, then crossed out and entered again.
| Address | Main Road, Hethersett |
| Place | Hethersett, Norfolk |
| Registration District | Henstead |
| Registration Sub-district | Humbleyard |
| Enumeration District | 6 |
| Schedule | 4 |
Source: Ancestry - 1921 Census