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...1Kentnn <trnunt y <trnrnner's ®ffire...
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nquest No. �
Receiv �tt ice
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�onths
White-Geleret;l-Male
Nativity �
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Mlllllitd-Single -�-\3.webceer.
Occupation /'1/IJL<Ac..J,
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Father's Name �a../l.£(,{)
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Mother's
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Next Friend
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�L.JkDate of Death
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Place of Accident
Nature Injuries
_
_
____
_ _
_ _
_ __ _ _____
_
_ _
_____
_
__
_
_
_
Cause of Death
________
_
Post Mortem
_ ___ _ _ _____
_
Names of Jurymen
______________ _ _ ______
__________
_
:Sames of Witnesses
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Qu.w,.L��&-«-C..rt-r
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i1'11dertaker
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.
Fees
Height
Nose
Beard
Paid
________
rkscRlPTION WHEN UNKNOWN
Weight
_ _ _ _ _
lfair
___ ___
_
Eyes
_____ _
Chin
_____ _
_
Neck
_ _ __
_
Teeth
___ _ _
Mustache
_________________
_
Scars, �arks, De�r1nities, Etc·,
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-
-
-
---
-
-----
--
-
-
-
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-
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Clothing
Contents of Pockets, Etc.,
_
_____ _ _ _
Remarks:
------- - -----�
VERDICT:
_______ ________ _
Signed
____ __
_
_
__
__
_ _
_
Coroner.