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P. M.
Inquest No.
Received . }�
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19slo, _
A
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�Qr.Ind��
Residence_N�
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_
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White-� z ale�Fe...ale.
Age
"5°<£'
7
Years
Months
Days
ativity
��
How long in Co y, nty?
__
Married-�e-�-\\liaswer.
Occupation
G��
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_ _ _____ _ ___
Mother's Name
_________ ____
Estate
T
Next Friend
Place of Death
lll1.J.£
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�ate of Death �.:M', /
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Body Fonnd
_ _
7_
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______________
__ _ _ _
__...,_
_____
Place of Accident
Nature Injuries
Cause of Death
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Post Mortem
.3
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Xames of Jurymen
___ __ _
� - - - -
�ames of Witnesses
_________ _ _ _ __ __
_ _ _______________
Undertaker ��&:?
Fees Paid
________
DESCRIPTION WHEN UNKNOWN
Height
Nose
Weight
____ _ _ _
Chin
______ _ _
Hair
_
_______
_
Eyes_
Neck
_ ____
_
Teeth
_______
Beard
Mustache
_________ ________
Sra�, Marks, Defurmities, Etc,
_____________ __ ______________
_
Clothing
--
--
��- - - - - - -�
=
=
-
-
Contents of Pockets, Etc.,
_
_
_
__
_
_
__
_
_
RemarksMl.
OJF �
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QevJ.
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VERDICT:
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Signed
______
_
________ ___
Coroner.
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