| Address :- | 17 King's Cottages, Bishop Stortford |
| Name | Rel | Age | Sex | Marr | Birthplace | Nationality | In Education | Profession / Trade | Employment | Place of Work | Children <16 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 |
| Dina ROAST | Head | 69y 09m | F | Widowed | Herts, Bishops Stortford | Pensioner |
| Number of Rooms | 2 |
| Signature | Dinah ROAST |
| Postal Address | 17 King's Cottages, Bishop Stortford |
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