Coroner's Book

385 / 1028

P. M.
· � Days
er.
...l(rutnu arnuuty Qinrnurr�s ®ffirr...
371
Inquest No. N"- ' := 1 · ,,,v, �, , 19.:->Q __A. M. _ _ P. M.
Naml'
Residence
Wfilte-Colored-Male-�male. Age .;) I LI Years Months --- Days , [7
Nlii.ty How long in County?______ _
Married-Single-Widow-Widower. Occupation____________________
Father's Name Mother's Name_ _ _ _ ______ _ _
Estate_ ______ _________ Next Friend_____ _ _ _______ _
Place of Death_ _______ _____ Date of Death______ _______
Body Found__________ _ _ __ ___ _ _ _________
Place of Accident_ _______ ___ _____ ___________�---
Nature 1njuries_ ____ _______________________ ______
Cause of Death ,- - �-..... '-"'-J - l/\,./VV:'-"'V',,.""'1L"�,, ..._,
Post Mortem --- ---- - - ---- ----tt-- -------- -------- --
Names of Jurymen___ ___________________ _ ___________
Names of Witnesses ______________ ___________________ ____
Undertaker___________ ____ _ _ _ ____ Fees Paid________-'-
Height
Nose
Beard
DESCRIPTION WHEN UNKNOWN
Weight_______ Hair________ Eyes
Chin_ _ _ __ Neck_ _ __�- Teeth_____ _
Mustache_ _ __ _ _ ______ _____
Scars, �arks, De�rmities, Etc.,---------- ----·--------�------ -
Clothing
Contents of Pockets, Etc.,___ ____ ____ _ _____ __ _____ _ _ __ _ _
Remarks:_______________________________ .____ _
VERDICT:___________________
�
-1
Signed Coroner.