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| First Name | Middle Name | Last Name | Alias | Registration number | Date of registration | Date of certification | Age | Gender | Color | Height- Feet | Height - Inches | Marks or scars | Eye color | Description of hair | Speech | Name of mother | Color of mother | Free status of mother | Name of father | Free status of father | Name of spouse | Free status of spouse | Name of children | Free status | Where emancipated | Who emancipated | Place of birth | Date of birth | Previous place of registration | Name of clerk | Additional information |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| S. Poindexter |
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