Form used between 1878 and 1881
Port of Embarkation Names of Passengers Age of each Adult of 12 years and upwards Married M. F. Single M. F. Children between 1 & 12 years M. F. Infants M. F. Profession, Occupation, or Calling of passengers English Adults Males Females Between 1 and 12 Males Females Infants Males Females Scotch Adults Males Females Between 1 and 12 Males Females Infants Males Females Irish Adults Males Females Between 1 and 12 Males Females Infants Males Females Foreigners Adults Males Females Between 1 and 12 Males Females Infants Males Females Port at which Passengers have contracted to Land