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Page type: Entry form

Item number (top right of entry form): 401

Image number (corner of image sample itself - leave blank if not visible):

Date of registration stamp: 16 Mar 1885

Date form completed (next to signature): 14 Mar 1885

Description of work: [crossed out: "French coffee label centre panel"] Drawing of Moonlight Scene Notre Dame in a Circle Sprays of Coffee plant on the top and bottom (copy annexed)

Date of Agreement or Assignment:

Names of Parties to Agreement or Assignment:

Name and Place of Abode of Proprietor of Copyright (use commas): Lewis & Sons, 55 Eastcheap, City, London EC

Name and Place of Abode of Author of Work (use commas): Edward Henry Bott (in the employ of White & Pike), Moor Street, Birmingham

Approximate height of image sample (cm):

Approximate width of image sample (cm):