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...il(eutnu Qlnu:ut y Qlnrnuer

'!I

®ffire...

I N n a q

m ue e s�

'&

1 �ceived;tic,c �

7:,

o

'J

'/

_,

,

9

So,

A

M.

7/(P.

M.

Residence��

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I�� ·

J}i;;;..,

7:

-

@ci�

_

_

_

_

___

_

Years

___

Months

White 8�d-MQ 1e-Female. Age

Nativity�a,w,I

�lfbw long in

Cou'!tyl

_

_ __

Days

,l)"arrJed

;::-

'.,!;le-lA!i4<,w-�er.

Occupation

___

�_Jy!_·�

.

�Nam�'-' £0

��

Mother's Name

__

Estate

{

Place of Death

3'2,

o

I

W

uX:l)�

.M

·

Next Friend

______

,,_

_ _____

_

Date of Death

____..

?n�-;/,�

��

_,,

_,_,

_,/

,-

.-9-=

S

_.o.....___ _

Body Found

__

-L.>.

-

-

- - �

-

-

-

'

-

-

-

-

-

-

__

- - -

"

--

Place of Accident

____ _ _ ____ ___

_

Nature Injuries

_

__ _ __

__

_

Cause of Death

_

.__=��--=->-..-;-

--c-\c�

·

Post Mortem

_____ _ ___,__

.

Names of Jurymen

___ _ _ ______ _ _ _

_

Names of Witnesses

__

_

_

_

______

_

_______

_ _ _ _

_ _ _

_

_

___

__

_

Undertakej"""�-

C.-

Y5.J.:U

Fees Paid

____

_

DESCRIPTION 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.