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White Gelal"ed-Mftk-Fema(;J Age
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Nativity
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Occupation
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Father's Name �
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Date of Death
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Place of Accident
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Nature Injuries
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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___________________ ______________
Undertaker
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Fees Paid
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DESCRIPTION WHEN UNKNOWN
Height
Weight
Hair
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Eyes_
Nose
Chin
Neck_
_____
Teeth
Beard
Mustache
Scars,
Marks,
Deformities,
Etc.,
Clothing
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Contents of Pockets, Etc.,
_________ _
Remarks:
_____________ ______________________
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VERDICT:
__________
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____
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Signed
Coroner.
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Nam
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Whit
Nati
Marr
Fath
Estat
Place
Body
Place
Natu
Canse
Post
Name
Name
Uude
Heigh
Nose
Beard
Scars,
Clothi
Conter
Rema
VERDI