Created by gemini-2.0-flash-lite on 2025-05-09

The image is an old form, likely used in the early 20th century, for documenting milk samples from stores in the city of Fitchburg. The form is printed on light blue paper and features a city seal in the top left corner. It's titled "CITY OF FITCHBURG. MILK FROM STORES." and contains numerous fields: sample number, date, time (with options for AM/PM), proprietor of the store, store number and street address, where the sample was obtained from, the type of container the sample was taken from, the amount of milk in the container, name of the milkman, any marks on the can, location of the milk when the sample was taken, and space for remarks.

Created by gemini-2.0-flash on 2025-05-09

Here is a description of the image:

The image shows a light blue form titled "City of Fitchburg" with the subtitle "Milk from Stores." It's a document likely used for recording information about milk samples taken from stores within Fitchburg.

At the top left is a circular seal with the word "Fitchburg" and the words "A TOWN, FEB. 3, 1764. A CITY. MAR. 8, 1872." around the circle, featuring a landscape scene inside. The form includes spaces for various details, such as the sample number, date, time (with AM/PM), proprietor of the store, store number and street, where the sample was obtained from, whether the sample was taken from a quart can, the amount in the can (in quarts), the name of the milkman, any marks on the can, location of the milk when the sample was taken, and any remarks. The form is lined and dated "191_" suggesting it's from the early 20th century.