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21

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Inques

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No.

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Received Notice

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Name

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Residence@��....

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,ggs

White - �Male-Female. Age�

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Years

� Months �

£:

Nativity �cJ

How long in County?

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Estate

Next Friend

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Date of Deat

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Place of Accident�

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Nature Injuries

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Cause of Death

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Post Mortem

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Names of Jurymen

____

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_

_

_

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Names of Witnesses

______ _ _ __ _ _ ________ _ _ __

_

Undertaker

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ev

DESCRIPTION WHEN UNKNOWN

Height

Weight

Hair

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Eyes

Nose

Chin

Neck

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Teeth

Beard

Mustache

Scars,

Marks,

Deformities,

Etc.,

Clothing

--

-

-

---

-

-

-

-

- -

-

-

- -

-

-

--

-

-

-

-

---

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--

--

Contents of Pockets, Etc.,

--

-

--

-- ___

_

V E RDICT:

_ _ __ __________ ______

_

Signed

__________________

Coroner.