323 / 1028
.
s
..JKrutnu Qlnuuty Qlnrnurr�s ®ffirr...
===
�
101
=
==
Inquest No. t-;;
.
Recei� Notice
�� :J..
Z, 19
3
o,
i_z_A.
M.
Name
..
1:!::':'"L �
\.9'�
0
R
es
i
de
n
ce
_
2
�
!f
-
�
�J>-:f;:/-
J::/:..
()�
'>- �
<ff�
<hr( )
�
O)'-
/'tf,
P. M
.
\Vhite-
e.rnry..
d
-
M:rh,
-Female.
·
Age
cSc
Years
- Months
'-/
Days
i\ativity__ll_g,.j
Wait
�
How long in County?
_
�larried-�le-\¥+4@w-\Vid0wer.
Occupation
;JI�
W�
Father's Name
hl�
(.°
CJbr
o ""'�
Mother's Name
'f)Q.,1.,'?,
"��...�
Estate
__
Next Friend
____
U
__________
_
Place of Death
"----¥-
J� Al
"
Date of Death
a'-<-
a
!.! 2
I ��
0
Body Found
.
Place of Accident
,.
i\ature Injuries
__ _
'•
I
Names of Jurymen
_
_
_ _
__
_
_
_
__
__
_
____
_
__
__
_
__________
Xames of Witnesses
_
__
___
_
______
_
_
_
__
_
__
_ _ _________
_
_
_
_
Vnclertaker____ _ _______________ __
Fees Paid
_______
_
Height
Nose
_
Beard
__
____
_
DESCRIPTION WHEN UNKNOWN
Weight.
_ ____
_
Chin________
Hair
_ _ ___
_
Eyes.
_______
Neck
Teeth
_ _ ____
Mustache
_ _____________�
s�n,
Marks, Defur1nities, Etc.,
_________________________
_
_
____
Clothing
-
--
--
-
-
Contents of Pockets, Etc.,
_
_
Remarks:
_
_
_
______
V F. RDICT:
_
____ _ _
__
__
__
__
__
_
------ --
Signed
_Coroner.