Coroner's Book

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P. M. I uest �G/ Rec?'j�No· e_-+µ� �,,,____ __LJ- , 19� __A. M.
Name�� � �l=a:;;)"'----'-'"«-- ---+"-;-- -- ------ --�
R .d / es1 ence______ _ __ _ _ _ � --- --------- - - -
--�_l___ _ Years White ��red-Male-liiiiii1tle. Age
Nativity �� �,-.---j?t
___ _ Months __ _Days
How long in County?__ _
Married-Single-Widow-Widower. Occupation_ _ _______
Father's Name________ _ __ _ Mother's Name______ _ __ _ _
Estate_ ___ _ __ _ _ _ ___ Next Friend__ _ ________
Pla!e of Death____ _ __ _ __ _ Date of Death____________
Body Found_ _ _ ________ _ _______ ______ __ ____ _
Place of Accident______ ___ _____ _
Nature Injuries_ _ _______ _
Cause of Dea - th -
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_ _J_l _ � _· Post Mortem l --d-
Names of Jurymen________ _ ________ _______ ___ _
Names of Witnesses_ ______ _ _____________ _ _ ___ _
Undertaker____________ ________ Fees Paid_ _ _ __
DESCRIPTION WHEN UNKNOWN
Height_ _ _ _ _ Weight__ __ _ _ Hair_ ___ __ Eyes___ _.
Nose____ _ _ _ Chin_ _ ___ _ Neck_______ Teeth_ _ _ --'---
Beard__ _ _ _ _ ______ Mustache_ _ _ _ ___ _ ____ _
Scars, Marks, Deformities, Etc.,_ _ __ _ __________________ _
- - -- - - Clothing______ _ _ _ ___ _ _ __ ___ ____ _ __ __
Contents of Pockets, Etc.,___ _
Remarks:___ _________ _ _ __________ _ ___ _
VE RDICT:____ _ _ ___________________ _ _ _
. , Signed ,=--________________Coroner.