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Received the [blank] day of [blank] of

[blank] a Relieving Officer of the Newport Union,

the sum of [blank] being

[blank] Weeks' Relief and to me the [blank] day

of [blank]


I, [blank] the Minister (or Churchwarden)

of the Parish of [blank] In the County of [blank]

do certify that [blank] is now residing in this Parish

and in circumstances to require the continuance of Parochial relief.

Minister (or Churchwarden)


Note. The above to be altered to suit existing circumstances and if any member of the Pauper's family shall
have died or obtained employment between the intervals of furnishing the Certificate, that fact should be stated, together
with the date of the occurrence.



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