| Schedule | Surnames and Other Names | O,V,S,P, or L | M or F | Birth | S,M,W, or D | Personal | See Instructions |
| 109/1 | Hanks, George H | Male | 15 Jan 1881 | Widowed | Colliery Hewer. Practically Disa[bled] | ||
| 109/2 | Chaproniere, Edith E. | Female | 14 Dec 1893 | Married | Household Duties |
Source: findmypast - 1939 Register RG101/1678H/011/16