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If this page displays an entry form with no image sample visible, please categorise 'Entry form' and transcribe all fields except the height and width of the image sample.

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Page type: Entry form

Item number (top right of entry form): 638

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

Date of registration stamp: 6 January 1887

Date form completed (next to signature): 20 December 1886

Description of work: Drawing. Cigar box label"The Craft Cigar" four corner pieces and view in centre (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): Henry Fox, Pontypool, Mon

Name and Place of Abode of Author of Work (use commas): T H Laurle, 7 Milk St, Bristol, employed by Mardon Son & Hall, The Caxton Works, Bristol

Approximate height of image sample (cm):

Approximate width of image sample (cm):