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230

...if(eutnn <tinu:nty Qlnrnner�

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®ffire...

Notice

_

-

·

·

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O

__

,

r9�

Name

_

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��"'-

���

-

-

x

A. M.

Y

bP.

M.

Days

White-�ed- , Male

Female.

� ge

_6,_f_ a s

__

LMonths

Nativity

(!?�

How long in County?

_

�d-Sing��er.

Occupation

____

Father's Name �"� ��

Mother's Name Gaeiena�.q -���

I

I

CJ)

Estate

C

Next Friend

·

-

--

- -�

--

i

'l--

-----

-

-

-

Place of Death \�'\

'\!\,\

o.;t;......�

Date of Death

'}y]��-

Body Found_____,_,\

1-- -�---�---

_

,

,

_

_

_ _

_

I.I _

Place of Accident

_____ __

_

Nature Injuries

______

_

Cause of Death

(l&t4

a1r

£,;td.-,

f

Jfuvt/

Post Mortem

____ _ _ ___

_

Names of

Jurymen

__

_

__

_

______

__

_

------

-

-

·

-

-

----

-

-

-

-

Names of Witnesses_______ _ ___________ _________

Undertaker

Fees Paid

_____ _

OESCR.IPTION 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.