325 / 1028
P. M.
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\Vhitc €olo1cd-Male -Female
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Age
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Years
Months
Days
Nativity
How long in County?
_______
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W1.d.awe,r,
Occupation
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Fathcr's Name
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Next Friend
Place
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ate of Death
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Body Found
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Place of
Accident
_ _
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_
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_
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___
_ _
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_____
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Nan�es of Jurymen
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Names of
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Fees Paid
_ ______ _
Height
:'1ose
Beard
DESCRIPTION WHEN UNKNOWN
Weight_ _ _ __
Chin____ _ _
Hair
_ ____ _
Eyes,
_______
Neck
Teeth
______
_
l\1ustache
_ _________________
Scars, Marks, De�rmities, Etc,
______ _ ____ _ _________________
Clothing
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Contents of Pockets, Etc.,
___
_
__ _
_
_
_
_
_
_
_ _ _
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_
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Remarks:
____
_
VERDICT:
__
_
____
_____
_
_
_
_
_
_
_
Signed
Coroner.