| Address :- | 57 Beaconsfield Road Southall |
| 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 |
| Walter Leonard GREEN | Head | 45y 11m | M | Married | Malmesbury, Wiltshire | Railway Police Inspector | Metropolitan Railway Company | Baker Street Station NW1 | ||||||||||||||||||
| Jane Alice GREEN | Wife | 45y 11m | F | Married | Dublin | Home Duties | ||||||||||||||||||||
| Stanley Leonard GREEN | Son | 18y 11m | M | Single | Willesden, Middlesex | Apprentice Armature Winder | Submersible Motor Co | Johnson St, Southall |
| Number of Rooms | 5 |
| Signature | WL GREEN (Head) |
| Postal Address | 57 Beaconsfield Road Southall |
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