234 / 1028
228
...if(eutnu Qlnu
_
ut y illnrnurr�s ®ffirr...
==
�101
===g=
otice--2'71
_
cfv
_£
__
,
r9__d_D,
,3.<,
_A. M.
7
P.M.
Residence____L_.!O�����:�-
@rz,:
-/�
White-Colored-1\k+e-Female. Age
Years
Months
Days
Nativity
(1£4
h
-<'l1<'\
a)
How long m County?
_
_ _
MarrierJ-S+ttgle-Wi � w-Wif™r·
Occupation
7111>1\'
�
Father's Name
Jtfn-i
�:;::.,
0 Mothds Name {2��-
Estate
Next Friend
____ ____
�
------
Place of Death
flJ.e(
Date of Death
IJn;{,.
cfi.
I
9
.3
0
Body Found
t1.NC£7�
G3c11111.
,/)/
(au« .C2_
Place of Accident______ _
Nature Injuries
_
_ _ _
_
_
_
__
_ ___
_
__
_ _
_ __ __
_ _ __
·
�
Cause of
D
ea
th
���,4--1
...,__,�
..._..
CII-L
x...\
::.-
•
�
Post Mortem
_ ______ _ _ _ _
Names of Jurymen______ __________ _
_ _ __
_ __ _ ___
Names of Witnesses_ _ _ _ _ _________________ _____
Undertaker
/ff:::
{;�
J:
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:____________ _ _ ____ _________._____
V E RDICT:
__ _ ___________________ _
....
Signed
_
___________
__ _
___Coroner.