434 / 1028
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Inquest No.
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Received � e
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19A_I,
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Name
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Residence_
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White-ecrluied-Male
Female.
Age
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�ars
Months
Nativity__________ ______ _ ___
County?
_
Married eiH�-Widaw
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Father's Name
Mother's Name
_____________
P. �I.
Days
Estate
Next Friend
_
_
_
_ _
_
_
___ __
__
Place of Death ��
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Date of Death
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Body Found
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Place of Accident
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Nature Injuries
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Cause of Death �<!A.
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Post Mortem
_______ _______
_
Names of Jurymen
________________ ___
_
Names of Witnesses
___
__
_
_ ___
_
_
_
_
__
_
____
__
_ _____
_
_
__
_
Undertaker
Height
Nose
Beard
�rL.
-
DESCRIPTION WHEN UNKNOWN
Weight
Hair
--
Eyes_
-
Chin
Neck
_ __
Teeth
- --
Mustache
Scars,
Marks, Defonnities,
Etc.,
Clothing
-
-----
-
-
-
-
--
-
-
--
-
- -
Contents of Pockets, Etc.,
______ _ ______
_
Remarks:
_______ _ _ _ _________________________
_
VE RDICT:
__
__
__
_
___
__
_
_ _
_
_
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Signed
Coroner.
Inquc
Name
Resid
Whit
Nativ
Marri
Fathe
Es
tat
Place
Body
Place
Natur
Can!-e
Post
Name
Name
Uncle
Heigh
Nose
Beard
Scars,
Clothi
Conte1
Rema
VERDI
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