| Registration District | Poole | County | Dorsetshire |
| Address | Wimborne Road Poole Dorset |
| Census Reference | RG14PN12283 RG78PN695 RD 261 SD2 ED8 SN148 |
| Surname | First Name | Rel | Age | Sex | Marr | Years Marr | Born Live | Living | Died | Occ | Industry | Employ Status | Work at Home | Birthplace | Nationality |
| LACY | Henry | Head | 58 | M | Single | General Labourer | Ship Worker | Worker | Wimborne Dorset | ||||||
| LACY | William | Brother | 56 | M | Married | Bicklayer | Worker | Wimborne Dorset | |||||||
| LACY | Walter | Brother | 48 | M | Widower | Bricklayer | Worker | Parkstone Dorset | |||||||
| LACY | Edward | Brother | 40 | M | Single | General Labourer | Ship Worker | Worker | Parkstone Dorset | ||||||
| LACY | Matilda | Mother | 86 | F | Widow | 11 | 9 | 2 | Wimborne Dorset |
| Number of Rooms | |
| Signature | Henry Lacy |
| Postal Address | Wimborne Rd Poole Dorset |
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