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If this page displays an entry form with no image sample visible, please categorise as 'Entry form' and transcribe all fields except the height and width of the image sample.

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Page type: Entry form

Item number (top right of entry form): 63

Image number (top right of image sample if visible):

Date of registration stamp: 14 January 1885

Date form completed (next to signature): 30 September 1884

Description of work: Drawing of an "Eme" Simplex Bath, (copy annexed)

Date of Agreement or Assignment: [30 September 1884, 12 January 1885 (crossed out)]

Names of Parties to Agreement or Assignment:

Name and Place of Abode of Proprietor of Copyright (use commas): Young & Marten, 5 Romford Road, Stratford, E

Name and Place of Abode of Author of Work (use commas): H A Long (in the employ of Howard & Jones), 16 Cullum Street, Fenchurch Street, EC

Approximate height of image sample (cm):

Approximate width of image sample (cm):