394 / 1028
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Inquest l'\o,
Received -Notice
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Whit � -Co � r � � -
-Male-Female.
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Years
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Months
Nat1v1ty � ... ;(:.. �-- -
Married Si Hg:le.. '.Alido:w-W�r.
Occupation
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Father's Name
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Mother's Name ," � ",,_
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Estate
Next Friend
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Place of Death
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Date of Death
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Body Found
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Place of Accident
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Nature In j uries
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Cause of Death
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Post Mortem _ ___
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Names of J urymen
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_____
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Names of Witnesses
__
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Undertakei
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Fees Paid_
DESCRIPTION WHEN UNKNOWN
Height
______
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Weight
______
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Hair
__
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Eyes_
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Nose ,
________
Chin________
Neck
_
_
__
Teeth__�
Beard________________�
Mustache
__
Scars, Marks, Deformities, Etc.,
__________________
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Clothing
____ __ ________
_
Contents of Pockets, Etc.,
_ _
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_______
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Remarks:
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VERDICT:
--------------------------
Signed
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