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Page type: Entry form

Item number (top right of entry form): 106

Date of registration stamp: 7 March 1884

Date form completed (next to signature): 4 March 1884

Description of work: A drawing of a champagne bottle, glass and cork (copy attached)

Date of Agreement or Assignment:

Names of Parties to Agreement or Assignment:

Name and Place of Abode of Proprietor of Copyright (use commas): Ackerman-Laurance, 41 Crutched Friars in the City of London

Name and Place of Abode of Author of Work (use commas): J. Waters, 61 Copleston Road, Peckham S.E.

Approximate height of image sample (cm): 15

Approximate width of image sample (cm): 9