Admitted
| Day of the Month | 1876 Decr. 2 |
| Day of the Week | Saturday |
| Nex Meal After Admission | D[inner] |
| Name | Hollis Davis [sic] |
| Calling, if any | Bricklayer |
| Religious Persuasion | Ch of England |
| When Born | 1805 |
| Class for Diet | 2 |
| Parish from which Admitted | Newington |
| By whose Order admitted | Bassett |
| Date of the Order of Admission | |
| Observations | Sick Married |
Discharged
| Date | 1876 Decr. 5 |
| Day of Week | Tuesday |
| Last Meal before Discharge | D[inner] |
| Name | Hollis Daniel |
| Class for Diet | 2 |
| How Discharged | Dead |
| Observations |
Source: London Metropolitan Archives; London, England;
Reference Number: SOBG/111/10
Source: Ancestry.com. London, England, Workhouse Admission and Discharge
Records, 1764-1930