Quality Family
Supports himself, at present, by
Lives at present Quarter, District, Street,
House, No Floor,
Can be considered as a Pauper belonging to this City, and ought therefore to be
Is capable of doing the following Work:
Could be trained to the following Occupations:
:fl.:kr.:
Could gain by this Work per Week—— : : :
Wants for his weekly Support———— : : :
Receives at present per Week from his own } : : :
Means, get by way of Pension, Alms, } : : :
and .. .. .. .. .. .. .. .. .. .. } : : :
Wants, therefore, a weekly Allowance of Alms of : : :
: : :
————-
:fl.:kr.:
{ Income of his own — — : : :
{ Earned by working — — : : :
{ Salary — — — — : : :
Enjoyed heretofore { Pension — — — — : : :
per Week { { From the Court : : :
{ Alms, { From the City — : : :
{ { From private Persons : : :
{ Got by begging — — : : :
: : :
:—-:—-:
Total : : :
: : :
————-
:fl.:kr.:
: : :
Pays House-rent — — — — — — — — — : : :
: : :
Has Bed of his own, the Value of which : : :
is about— — — — — — — — — — — : : :
: : :
Possesses other Utensils necessary for House- : : :
keeping, worth about— — — — — — — — : : :
: : :
Is provided with the following Working Tools: — : : :
: : :
————-