| Schedule | Surnames and Other Names | O,V,S,P, or L | M or F | Birth | S,M,W, or D | Personal | See Instructions |
| 140/1 | Stephenson Charles W | Male | 5 Sep 1904 | Married | Surgical Technic[ian] | ||
| 140/2 | Holder (Stephenson) Lylie A | Female | 20 Aug 1904 | Married | Unpaid domestic |
Source: findmypast - 1939 Register RG101/0572B/012/35