| Sub Registration | Stortford |
| Civil Parish | Hammersmith |
| County | London |
| Address | 87a Ormiston Road, Shepherds Bush W |
| Surname | First Name | Rel | Age | Sex | Marr | Years Marr | Born Live | Living | Died | Occ | Industry | Employ Status | Work at Home | Birthplace | Nationality |
| GOATES | Samuel | Head | 33 | M | Married | 14 years | 3 | 1 | 2 | Baker | Worker | Herts, Bishops Stortford | British | ||
| GOATES | Sarah Drusilla | Wife | 35 | F | Married | 14 years | Bucks, Great Kimble | ||||||||
| GOATES | Phyllis Mary | Daughter | 4 | F | Suury, Raynes Park | ||||||||||
| Nanet | Paul Marcel | Boarder | 18 | M | Single | Designer | Employer | At Home | Belgium (Resident) | French |
| Number of Rooms | 4 Rooms |
| Signature | Samuel GOATES |
| Postal Address | 87 Ormiston Road, Shepherds Bush |
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