464 / 1028
...if(eutnu <nnuut y <nnrnurr�s ®ffire...
====
�
101
==
==
Inquest No.
Received Notice
1t
,
''':_�-----1
(.._..._
,
19_
Name
J
�.\ ,
.. - --�� ·- .. �., �
......
Residence
�-- - ·· , ,
.
.
c· - -
- - ,
_
A.M
.
White-Cole-t=ed-Male-laiemale. Age
S-
0
Years
____
Months
Nativity
How long in County?
_ _
P. M
Days
Married-Single-Widow-Widower.
Occupation
_
_
_
_
_
_
_
__ _____
__
___
_
_
Father's Name____ _ _ _ _____
Estate
__________
_
_
_ _
_
_
_
Mother's Name
___
_
Next Friend.
_ _
_
_ _
_
_ __
_
___
Place of Death_____ _________
Date of Death
___ _________
_
Body Found
___
__
__
_
_
__ _
__ ___
_
__
_
Place of Accident__
-·
_
-
-
_
-
-
_
-
_
-
-
--
-
---
-
---
�
��
In
Na
Re
WI
N
fl,
Fa
Es
Pl
Bo
Pl
Nature Injuries
--
I
: I
N ·
Caus.e of Death
a=11a��
[
l-A
}
.
�.
u
.p,,,-
OC.
Post
Mortem
J'
·
--+-7,
�
...,
II
Ca
- -
- - . -
•
Po
Names of Jurymen
--
N
Names of Witnesses_________________ ___ ___ _ _ _____
Undertaker________________________
Fees Paid
__ __
DESCRIPTION WHEN UNKNOWN
Height
___ _ _ _
Weight
____ __
Nose____ _ _ _
Chin________
Hair
_ _
Neck_
_
Eyes
_
_
Teeth
____
_
Beard
Mustache
_ ______________
_
Scars, Marks, Deformities, Etc.,
________________ ____________
_
Clothing---------- - - ---
Contents of Pockets, Etc.,
______ ___
_
Remarks:___________ _________________________
VE RDICT:
_____________ _ ___
_
Signed
Coroner.
N'
' <
{J I
I
H
N
Ik
Sc:
Cl
Cc
R
Vi