Table of Contents Table of Contents
Previous Page  221 / 1028 Next Page
Information
Show Menu
Previous Page 221 / 1028 Next Page
Page Background

�(b,�

...lKrutnu Qinuut y Qinr1ourr'.a ®ffirr...

===

101

=

=

Received Noti �tJi,L,.-

1

l-,

19__3.o _

A

. M.

Narue

�MM.�

�'-'

- - -�--+-- - -

Residence � 0

"1

W

-

I-

CJ ,

M

\:�"

Inquest No.

\Vhite-�ed-Mme-Female. A � e

.J

'2

Months

P. M.

Days

Nativity

---\

How long in County?

___ _ _

�d-Single-�-�ver.

Occupation

---;t,

,----ft;,

Father's Name

\At!::'

L

k,,,,,

Cw0 Mother's Name���

Estate

d

Next Friend

·

Place of Death

�co

1

·

i.

I

'I •

Oi..

Date of Death

�6 ,

f

'f.3

ZJ

Body Found

___

_

_ _

______

__

_

_

_

_

_

_

_

_

-CL

--1---

-------1'----

---

Place of Accident

---------

--

-

� -

-

----

-

-

-

- - - ---- - - -

Nature Injuries

_

___

_ _

_ _ _

_ _ _ _ _ __ _

_

_

_ _

_ ___

___

__

__

Canse of Death

LJo

;�

-

ft;

@.�

,k,.M(J

-

Jr�

Post Mortem

I

James of Jurymen

_ _ ___________ _ ____ _ _ _ __________

.�ames of Witnesses

_ __

___

_

_ _ _ _

_

__

__

__

_

__

_ __

_

_____

_

__

Undertaker

fl

hA.

l

d.J..

p.. �� Fees Paid

DESC IPTION WHEN UNKNOWN

Height

Nose

Beard

Weight

____ _ _ _

Hair

___ _ __

_

Eyes

_______

Chin

_____ _ _

Neck

____ _ _

Teeth

______

Mustache

_ _ _ _ _ ____________

s��,

Marks, Defurmities, Etc.,

___

_

_

_ _ _ _

______

_

_

_

_

_ ___

_

_

_

_

___

_

Clothing

---

-

-

-

-

- - - ---

--

=

=

Contents of Pockets, Etc.,

____

Remarks:

____

_

_ _

_

___

_

_

_

__�--- ----- - - -- ---------

VERDICT:_

Signed

Coroner.

_,

--