Table of Contents Table of Contents
Previous Page  227 / 1028 Next Page
Information
Show Menu
Previous Page 227 / 1028 Next Page
Page Background

.

s

...if(eutnu o.tnuuty o.tnrnuer�

!i

®ffire...

===

101

==

P. M.

Inquest No.

Received . }�

:i./_'?l,J{_,

19slo, _

A

. M.

'amc

�Qr.Ind��

Residence_N�

��:,-_�

_

_____!C_L______ILL__=--------

White-� z ale�Fe...ale.

Age

"5°<£'

7

Years

Months

Days

ativity

��

How long in Co y, nty?

__

Married-�e-�-\\liaswer.

Occupation

G��

J-. ��

_ _ _____ _ ___

Mother's Name

_________ ____

Estate

T

Next Friend

Place of Death

lll1.J.£

@:,i,,

- l1'r,,r

·

�ate of Death �.:M', /

Ed

o

Body Fonnd

_ _

7_

______________

__ _ _ _

__...,_

_____

Place of Accident

Nature Injuries

Cause of Death

;ir:;_

,rr

"'I�L

----..

ua

Post Mortem

.3

� ({/

i?f/'11-<( er�

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 �

g.,sik<A-

QevJ.

-

=

t�

¥

VERDICT:

"J

o

Signed

______

_

________ ___

Coroner.

�\

rr