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21�
Inquest
Name
Residence
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A. M.
P. M.
Father's Name_____ _ _______ Mother's Name
_
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-
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Estate
______ __-----==-----� �
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Next Friend
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Place of
Death---(�-1---J---'.---�-�==-Jti::7--I-:_:____
Date of Death
____,i
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Body Found
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Place of Accident
____________ ______________ _ ____
Nature Injuries
______ ______________________ _ __
Cause of Death
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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.