| When and where born: |
Seventeenth May 1868, Park House, Shalden |
| Name, if any: |
John Cyril |
| Sex: |
Boy |
| Name and Surname of Father: |
Richard WELLER |
| Name and Surname of Mother: |
Eliza WELLER formerly BOTHAM |
| Occupation of Father: |
Farmer |
| Signature, description and residence of informant: |
Richard WELLER, Father, Park House, Shalden |
| When registered: |
Twentieth August 1868 |
| Signature of Registrar: |
Lewis Biddle, Deputy Registrar |
| |
Matthew Heath ?Moff, Superintendent Registrar |