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218

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101

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Inquest No.

Received Notice

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19

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A. M.

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Age

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Years -C/,f:!-Months

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Days

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iv

it

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How lo

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g in County?

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Mani@d-Single- ;w iSN

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Occup

ation

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Nex

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________ _ _ _

Body Found_______

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N

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ure Injuries

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_ ___ _ _ _

C

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use of De

at

h

Post Mortem

N

a

mes of Jurymen

_

_ _

___

_

_

_

_

_

__

_

____ _

___ _

____

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L...__

N

a

mes of Witnesses_____________________ __________

Under

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Fees P

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id

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DESCRIPTION WHEN UNKNOWN

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Be

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Mus

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Sc

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rs,

M

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rks,

Deformi

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ies,

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c.,

Clo

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hing____________ __ _ ____ __ _____________

Contents of Pocke

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s, E

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c.,

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Rem

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rks:__________________________ __________

VE RDICT:

___ _____ _ _ __ ___ ___

--'-- - - -

-

Signed

- -- ---- - -�--- ---Coroner.