329 / 1028
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Inquest No.
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Namc
Residen ce
Age
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Years
Months
Days
Nativity
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How long in County?
Married-Si@�\N.
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Occupation
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Father's Name
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Mother's Name
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Estate
Place of Death
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Next Friend
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D ate o fDeath
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Place of Accident
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Nature Injuries
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Ca11se of
Death
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Post Mortem
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�amcs
of Jurymen
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�amcs of Witnesses____________ __________ _ ___________
Undertaker
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Fees Paid
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DESCRIPTION WHEN UNKNOWN
Height
Weight
Hair
Eyes
_ ___ _
Nose
Chin
Neck
Teeth
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Beard
.
Mustache
Scars,
Marks,
Deformities,
Etc.,
Clothing
Contents of Pockets, Etc·,
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Remarks:
______ _ __ ____________________ _ __
_____
VE RDlCT:
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Signed
Coroner.