Coroner's Book

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P. M.
oays
er.
NameResidence
...il(eutitu (!lnuuty <nnrnuer�.a ®ffire··�
�.. _.,_,.. ' "' , I9�-, __A. M. _ P. M.
Age ')_ '?, Years ____ Months Days
How long in County?________ Nativity___�}:_�'\---- - -----:�== =:---==- M-art1'e'tt-Single-W'icl'n'w- WJ.gmW;J;;., Occupation___ _____________ __
Father's Name 'JY\, '{� Mother's Name______________
Estate_ Next Friend·----- -�--------
Place of Death (];i.,.,J-e �f.J..- Date of Death � l O / 'iJo
Body Found______________
�Ml�-� �� · Place of Accident �....1...< � �
Nature Injuries _ ____________________ _____
Cause of Death � �{\,,Q.
Post Mortem 0..t C-4,N,..,,l)(J ��M�� . J&�hudl�
�
Names of Jurymen___________________ ____________ ____
Names of Witnesses - - ---- ---- -- --------- -- -------- ----
Undertaker ------------------------ Fees Paid _________
Height
Nose_
Beard__
DESCRIPTION WHEN UNKNOWN
Weight_______ Hair______ _ Eyes._____ _
Chin________ Neck_______ Teeth.______
Mustache___________________
Scars, Marks, De�rtnities, Etc.,-------- ------ -------------�---
l
Clothing-- -------- --- - - -
Contents of Pockets, Etc., __ _______ _____ ________________
VERIJICT: __
Ll&
Signed Coroner. t\