| Last Name | First Name | Race | Sex | Age | Relation-ship | Single, Married or Widow | Occupation | What is the sickness or disability? | Blind | Deaf, Dumb | Idiot | Insane | Place of birth | Father's place of birth | Mother's place of birth |
| Shaw | J. L. | W | M | 42 | blank | Married | Supt. Of County Poor House | blank | blank | blank | blank | blank | Tenn | blank | blank |
| Avrett | Thos | B | M | 75 | blank | Widow | Pauper | Old age | blank | blank | blank | blank | VA | VA | VA |
| Barnett | Darki__(?) | W | F | 58 | blank | Single | Pauper | Weak Breast | blank | blank | blank | blank | Tenn | NC | NC |
| Body | Isaac | Mu | M | 70 | blank | Widow | Pauper | Consumption | blank | blank | blank | blank | VA | VA | VA |
| Ellis | Susy | W | F | 75 | blank | Single | Pauper | Womb Disease | blank | blank | blank | blank | Tenn | Tenn | Tenn |
| Green | Dick | Mu | M | 65 | blank | Widow | Pauper | Gravel | blank | blank | blank | blank | NC | NC | NC |
| Horton | Mallie | B | F | 11 | blank | Single | Pauper | Scroffula | blank | blank | blank | blank | Tenn | Tenn | Tenn |
| Luten | Mary | W | F | 71 | blank | Single | Pauper | Rheumatism | blank | blank | blank | blank | NC | NC | NC |
| Malone | H. A. | W | M | 12 | Son | Single | Pauper | blank | blank | blank | blank | blank | Tenn | Tenn | Tenn |
| Malone | Harvey | W | M | 77 | blank | Married | Pauper | Asthma | 1 | blank | blank | blank | NC | NC | NC |
| Malone | John | W | M | 8 | Son | Single | Pauper | blank | blank | blank | blank | blank | Tenn | Tenn | Tenn |
| Malone | L. E. | W | F | 5 | Daughter | Single | Pauper | blank | blank | blank | blank | blank | Tenn | Tenn | Tenn |
| Malone | L. F. | W | F | 34 | Wife | Married | Pauper | blank | blank | blank | blank | blank | Tenn | Tenn | Tenn |
| Malone | R. W. | W | M | 1 | Son | Single | Pauper | blank | blank | blank | blank | blank | Tenn | Tenn | Tenn |
| Mathews | Emily | B | F | 65 | blank | Single | Pauper | Dyspepscy | blank | blank | blank | blank | VA | VA | VA |
| McAdams | John | W | M | 76 | blank | Single | Pauper | Dyspepscy | blank | blank | blank | blank | Tenn | NC | NC |
| McGee | Richard | B | M | 30 | blank | Single | Pauper | Idiot | blank | blank | Yes | blank | Tenn | Tenn | Tenn |
| Patterson | Clara | B | F | 36 | blank | Single | Pauper | Idiot | blank | blank | Yes? | Yes | Tenn | Tenn | Tenn |
| Tabb | Polly | B | F | 75 | blank | Single | Pauper | Old age | blank | blank | blank | blank | VA | VA | VA |
| Thomas | Benjamin S. | W | M | 79 | blank | blank | Pauper | Broken Arm | blank | blank | blank | blank | NC | NC | NC |
| Walton | Patsy | W | F | 44 | blank | Married | Pauper | blank | blank | blank | blank | blank | Tenn | NC | NC |
| Walton | S. A. P. | W | F | 15 | Daughter | Single | Pauper | Insane | blank | blank | Yes | blank | Tenn | Tenn | Tenn |