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Page type: Entry form

Item number (top right of entry form): 106

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

Date of registration stamp: 17 May 1900

Date form completed (next to signature): 17 May 1900

Description of work: Oil Painting entitled "The Bouquet" representing gentleman on horseback handing up bouquet to lady at open casement. (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): Charles William Faulkner, 79 Golden Lane, London, EC

Name and Place of Abode of Author of Work (use commas): Alfred William Cooper, 4 Manor Road, Twickenham, Middlesex.

Approximate height of image sample (cm):

Approximate width of image sample (cm):