| Name and Surname of each erson | Relation to Head | Condition | Age | Rank, Profession, or Occupation | Where Born | Blind or Deaf- and-Dumb |
|---|---|---|---|---|---|---|
| Charles FORMAN | Head | Married | 41 | Inspector Engineering Dept Midland Railway | Hootsh, Leicestershire | |
| Maria L FORMAN | Wife | Married | 34 | Leicestershire | ||
| Miriam FORMAN | Daughter | Single | 14 | Hoockeh, Leicestershire | ||
| Ida E FORMAN | Daughter | Single | 13 | Hoockeh, Leicestershire | ||
| Elizabeth ILLSTON | Mother-in-law | Widow | 77 | Lutterworth, Leicestershire |