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Inquest No,
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_
A. M.
P. M.
Name
_________�---
White-Colored-Male-Female.
Age
_________
Years
__
Months
___
Days
Nativity
I--;Iow long in County
?
_
Me:t-?iCd-Single-�-�liE1@ov�.
Occupation
__________________
_
Father's Name_____________
Mother's Name
______
_
Estate______��---------
Place of Death
S.f
li
/
Body Found
O
Next Friend
_________
�--
--
Date of Death
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__
Place of Accident
.
_______________
_
Nature Injuries
_________________________
_
'I
Names of Jurymen
_
___
______
_
_
_
____
Names of Witnesses_______________________________
Undertaker
__
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_
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-
-----
-
---
Fees Paid_
()
DESCRIPTION WHEN UNKNOWN
Height·----�--
Weight_______
Hair
__
_
Eyes_
Nose________
Chin________
Neck
_
__
Teeth
__
_
Beard_________________
Mustache
_______________
_
Scars, Marks, Deformities, Etc.,
_
_____
_
_
__
____________
__
_
_
Clothing
___________________________________
_
Contents of Pockets, Etc.,
____________
_
R
emarks
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--
----------
-
----
-----
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-------
--
V ERDICT:
_________________________
_
Signed.
_________�__________
Coroner.
Inqu
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