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�101,
Inquest No
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Age
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Years
__ _
Months
Days
Estate___________ _ ____
Next Friend
_____________
_
Place of Death_________ _____
Date of Death
_____________
Body Found_________ _ _ ____________ _ _ ____
Place of Accident
___________ ___________
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______ __
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Nature Injuries
_______ _
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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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_______
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______
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Names of Witnesses_______ _ _______ __________________
Undertaker::
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Fees Paid.
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Height
______
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Nose_-,-______
DESCRIPTION WHEN UNKNOWN
Weight.
______
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Chin________
Hair
__
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Neck
_ _
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Eyes.
__
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Teeth
____
Beard__________________
Mustache
_ _ _ _ ___________
_
Scars, Marks, Deformities, Etc.,______________________________
Clothing------------- -----:- --
Contents of Pockets, Etc.,
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Remarks: _____ _ _ __________ _____ _ _________
VE RDICT:
________ ___ _____________________ _
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Coroner.
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