| Day of the Month | [1901] May 15th |
| Day of the Week | Wednesday |
| Next Meal after Admission | |
| Name | Mayersbach Jane |
| Calling, if any | Needlewoman |
| Religious Persuasion | C.E. |
| When Born | 67 [sic] |
| Class For Return for Form A | Not Able-bodied |
| Class For Diet | 4 |
| Parish from which Admitted | Islington |
| By whose Order Admitted | Thomas |
| Date of the Order of Admission | May 16th. |
| Observations on Condition etc. | W[idow] |
Source: London Metropolitan Archives; Reference Number: ISBG/283/046
Source: Ancestry.com. London, England, Workhouse Admission and
Discharge Records, 1764-1930