Table of Contents Table of Contents
Previous Page  220 / 1028 Next Page
Information
Show Menu
Previous Page 220 / 1028 Next Page
Page Background

21�

Inquest

Name

Residence

...if(eutnn <nn:unty <nnrnnrr�s ®ffirr..

:

,

_

,

19�

__

A. M.

P. M.

Father's Name_____ _ _______ Mother's Name

_

-+-

-1--

-

---

-

---

-

-

Estate

______ __-----==-----� �

_,__------r-----,.--

Next Friend

·

---

7""'1

- - - --

-

-

-

-

Place of

Death---(�-1---J---'.---�-�==-Jti::7--I-:_:____

Date of Death

____,i

__.

"""'�

/"--_

/

_

7_._

_

-

_

r==--.J,__j--"-

-

3

_7J

__

Body Found

Place of Accident

____________ ______________ _ ____

Nature Injuries

______ ______________________ _ __

Cause of Death

fu

r

CU

Post Mortem

__

_

__

_

_ _ _

_ _ _

_

__

___ _

_

Names of Jurymen

______ _ ________ __ ___

_______ _

_

Names of Witnesses_________ _______________________

Undertaker

C,£�

Fees

Paid

�ESCRIPTION

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.