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Page type: Entry form

Item number (top right of entry form): 237

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

Date of registration stamp:

Date form completed (next to signature): 3 March 1886

Description of work: A drawing of Mademoiselle Karma in her graceful gymastic potpourri. Female gymnast in two positions, in one of which she is walking head downwards along a ladder with exploding rungs over garden scene.

Date of Agreement or Assignment:

Names of Parties to Agreement or Assignment:

Name and Place of Abode of Proprietor of Copyright (use commas): Paul Dudeck, 23 Lisle Street, Cranbourn Street, WC

Name and Place of Abode of Author of Work (use commas): F Gerbeaux, 14 Leicester Place, Leicester Square, London

Approximate height of image sample (cm):

Approximate width of image sample (cm):