Coroner's Book

431 / 1028

P. M
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.C,� .- -.¢-� , 19-4-f, _A. M. _ _ P. M.
�ativity VVN t..�,.... 4i7 / NILY1-,.. Y r,...., How long in County?_ ___ _
Occupation �",""... ��
Father's Name � \...0) -R Q.... Mother's Name� 9n�
Estate _ Next Friend_ _ --t'\------ ----- Date of Death X� '2. .<:::::, J-1 Place of Death -·:a · .. / - - u a ,, , Body Found , "
Place of Accident
:,,:ature Injuries_ _ _ _ __ _ ____________________ _ _
Cause of Death ��cLa·�-�
Post Mortem- - - - -� --------- -- -- --- -- ---- - ---
Names of Jurymen__________________ _ ________ _____
Names of Witnesses______________________ _ ___ _ ______
Undertaker fk1._ / .� f:J� Fees Paid _ _ ___ _
DESCRIPTION WHEN UNKNOWN
Height._ ___ _ Weight_ _ __ _ Hair___ ____ Eyes_ _ __ _
Nose Chin_______ _ Neck_ ___ _ Teeth�-- - -
Beard Mustache_________ ______ .,__
s�ra, Muks, Defurmities, Et�,----- -- - ---- -· -------- --- ----
Clothing --- -- -------� - ---
--l
Con�n� of Pocke�, Etc.,__ _ _ _______ _ _______ _ _ _ __ _ _ _
Remarks: __ __ _ _ _ _______________________ _______
VERDICT:
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l Signed Coroner.
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