397 / 1028
P. M.
Days
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101
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Inquest No.
Received Notice
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19
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A. M.
P. M.
Name
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idence
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White-�-M111e Female. Age
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Years
Months
Days
Nativity
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How long in County?
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Married-�wk.J:=--w�
Occupation
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Father's Name
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Mother's Name
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Estate
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Next Friend
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Place of Deat
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ate of Death
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Body Found
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Place of Accident
__________________ _ _ ______________
Nature Injuries
_
_ _
_
_
_
_ _
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__
_
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_
_
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_
_
_
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_____
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Cause of Death
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Post Mortem
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Names of Jurymen
________ _ _ ____ _ ____ ___________
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Names of Witnesses
_ _ ______ _______ _________ ______
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Undertaker
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\��:,.,)�es
Paid
_-
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______
Height
Nose
.
Beard
Weight
_ _ ___
Hair
_______
_
Chin_____ _ _
Neck
______
_
Eyes
__
_
Teeth
_______
Mustache
_
______
_
___
_
_
__
_
___
ScaIB, Marks, De�rmities, Etc.,
______________ ______________
_
Contents of Pockets, Etc.,
_
_
_
_
_ _
_
_
_
_
_
___
_
_ _ _
_
___
_
_ __
_
_
---·
--
Remarks:
_
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Signed
Coroner.