388 / 1028
...l(rutnu <nnuu
<nnrnurr�
11
®ffirr...
.
Inq
uest
No.
9;l:)
�
�
_A.M.
P. M.
Nam
e
�
Re
s
id
e
nc
e
v
.;;J L �
(]:>��
Ag
e
b
O
Y
e
ar
s
Mont�
s
Whit
e
-Colored-Mal
e
-F
e
mal
e
.
Nativity
How long in Co
u
nty?
_
_
_
Days
Marri
e
d-Single-Widow-W
�
dow
e
r.
Occ
u
pation
___________________
--'----
Fath
e
r'
s
Nam
e
______________
Moth
e
r'
s
Name
________ _ _ _ ___
_
E
s
tat
e
__________________
N
e
xt Fri
e
nd
____________ ___
_
Plac
e
of D
e
ath_______________
Date of D
e
ath
____________
_
Body Fo
u
nd
_
_
__
_
_
_
_
_
______
_ _____
__
_
_
___
_
_
Nat
u
r
e
Inj
u
ri
es
�.n
�) .�
-
.3�
ow
"'�
di�
'.J
Cau
se
of
D
e
a�
h
�.::]
J,1.a,o./{'<
--
Post Mort
e
m
_
_
_____ ___
__
___
__ _
_ _ __
Name
s
of J
u
rym
e
n
_
_
___
_
_ ___
_ ____ ____
_
_
_
_
__
_
____
_
_
Nam
es
of Witn
es
ses
___
_
______________
____
_
_ _
_ _ _
_
____
_
Und
e
r
t
aker
L��
�
F
ee
s Paid
_______
DESCRIPTION WHEN UNKNOWN
H
e
ight
_______
Weight_______
Hair
_ ___ _
No
s
e________
Chin______ _
N
e
ck
_______
_
Eye
s
_
T
e
eth
____
_
B
e
ard
M
u
stach
e
________________
_
Scar
s
, Marks, Deformiti
e
s, Etc.,
_________________________ ____
_
Clothing_________________
-
��
�����--
-
Content
s
of Pocket
s
, Etc.,
_______ ____ _ ______ _ _______
_
Remark
s
:________________________ _________
VE RDICT:
________________ _ ____ __
_
Mil
,---\
Sign
e
d
Coroner.
Father
E
s
tat
e
Plac
e
Cl
Body
Plac
e
Nature
Caus
e
Post M
Nam
es
Nam
es
Unclerta
Height
No
s
e
Beard
Scars,
Clothing
Contents
Remark
Vi-:RDICT