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...il(eutnu illnuuty illnrnuer�a ®ffire..�

P. M.

Inquest No.

i

'2.- £.

Received Notice

-

·

-

o/

- ---

,

19

_A.

M.

Name

9P4,,-,yJN

·

--

Residence

Ir:,

1-1,

l.U

��\

I�

.

Jsi

�,nn_�

-

&

<--------«-

------

White-

::"'ri

--,

Mal,,

-

Female

.

Age

.,\-,ij\

ears

.l..

Montbs

"-

7

Days

Nativity

�trd(

jef.,

How long in County?

___

M,i11iHl--SM1r,+r Widow-

r-\

Occupation

4-

-

e...J�

-------

-

Father's Name

� �

Mother's Name

_

_

_______

____

_

Estate

Next Friend

Place of Death

1.1>

tJ

!'!!

U

{!JwL<

Date of Death

Z

Jf3tD

Body Found

..

''

,,

,.

,.

,,

Place of Accident

_ ___ _

Nature Injuries

___ ________

_

II

."'!.

,

..

Cause of Death

Q_CM.�

0...C:

·-

��

__

-=�

Post Mortem

_______________ _

Names of Jurymen

_____________

_

Na01es of Witnesses__________________ --'c- ----------------

'

Undertaker

r;,-

,=;:·

11,

-�, ---

Height.

___ ___

Weight______ _

Nose.

________

Chin

____

--'.__

_

Hair

__

_

Neck_

Paid_�-----

Eyes.

__

_

Teeth

·-

Beard__________________

Mustache_______ _ _________

Scars, Marks, Deformities, Etc.,

___

_

_

__ _

______

_

___

_______

_

_

__

_

Clothing

-

----

------

- -

---

Contents of Pockets, Etc.,

_

��

������

-

-

Remarks:

_

__

_

_____ _

_

__

_

___ _ _______

_ ______

__

_

VE RDICT:

__________________

_

Signed

Coroner.

Inqu Nam Resi

Nati

Marr

Fath Estat Place

Body

Place

Natu

Cause Post

Name

Name

Uncle

Heigh Nose

Beard

Scars,

Clothi

Conte

Rema

V..:1m