| Schedule | Surnames and Other Names | O,V,S,P, or L | M or F | Birth | S,M,W, or D | Personal | See Instructions |
| 19/1 | Evans, David | Male | 13 Aug 1880 | Married | Coppersmith | ||
| 19/2 | Evans, Ada E | Female | 5 Aug 1883 | Married | Unpaid Domestic Dut[ies] | ||
| 19/3 | Rawlings, Cedric D | Male | 28 Feb 1915 | Single | Copper Works General Lab[ourer] |
Source: findmypast - 1939 Register RG101/3488E/003/15