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P. M.

Days

(£__

n

,,

er.

Inquest No.

Name

Residence

...if(rutou <nouut y <noronrr�

,a

®ffirr...

>,

"ltie

u

�L. '9�3.

_

A

.

M

.

\Vhite--,,�d wt;als

Age

� /

Years

____

Months

�?-,.,_I

Ir--

Days

Nativity

lYlllAA.&<..«...-t;.,'I

=:L

Estate

Date of Death

.,

'-""

,.

,.

,.,

.

,, ., _ "

Place of Death

l:

r;;z

<l

,,

:ri ........

"LC?:4'

Body Found

,

.

,,

,,

. _

-1,

Place of Accident

Nature Injuries &wJ

J/:i

.__tu--rn,w,

J

-(j-:i,

(8a.(ec

4J

Q,,,,..,,..{'Pd)

/);;;tu"

ek, �

f

At

�aR

.

A¥U

fd!l_�cJ

�v�

� - ..

C?cu.

7,M

,.

Cause of Death

�;

;1,

-

cli· ti'

�U�t?JJ

&

2 � z,

/o �

Post Mo,tem

11:'

?

,Jr

Jl@

({;,

,

/

{t

.f'aA'"rL

Names of Jurymen

__

_

_

_

_

_ __

___ _ _

_

_

_

__

__

_

_____

_

_____

N�-�1 Witness<, ��

��i

_

�t��

�ij

.

� • �

,4

.

c.i.eo

m,_.i)

Undertaker

1.11

/n,eu�

vn/

!"?':

=v

Fees Paid

__

OESCRJPTION WHEN UNKNOWN

Height

-

Weight

Hair

_

_

Eyes_

Nose

Chin

Neck

Teeth

Beard

_

Mustache

�·

Scars, Marks,

Deformities,

Etc.,

Clothing

��

��

��

��� ���� � �

� �

� �

�� ���

Contents of Pockets, Etc.,

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----

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�-- -

-

·

-

- -

-- - - - --

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----

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Remarks:

__

____ _

_

___

__

_

_

_

_

VE RDICT:

_ ____ _ _

_

_

__

_

_

_

__

___

__

__

__

_

_

_

_

_

_ _

Signed

Coroner.

.

.

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