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|colspan=7|{{{place}}}
|colspan=3|PRO Reference: {{{pro}}} FHL {{{fhl}}}
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!rowspan=2|Page!!rowspan=2|PLACE!!colspan=2|HOUSES!!rowspan=2|NAMES of each Person who abode therein the preceding Night.!!colspan=2|AGE and SEX!!rowspan=2|PROFESSION, TRADE, EMPLOYMENT, or of INDEPENDENT MEANS.!!colspan=2|Where Born
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!Uninhabited or Building!!Inhabited!!Males!!Females!!Whether Born in same County!!Whether Born in Scotland, Ireland, or Foreign Parts.
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