469 / 1028
P. M.
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Days
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Inquest No.
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A. M.
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P. M.
Name
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Residence�
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White-Gele,ui Male-Eema\e. (\Age
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Years
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Nativity �
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How long in County?
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llarried-�WidQ.w 'WiOow,,.
Occupation �W"\/\•
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Father's Name
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Mother's Name
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Next Friend
____________
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Estate
Place of Death
__________ _ _
Date of Death
_
___ _ _
__
_
___
_
Body Found
____
_
Place of Accident
Nature
I
njuries
_
\
Cause of Death
_
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Post Mortem
______ _ _ _
Names of Jurymen
_ _ _ _ __________________ ___________
_
Xames of Witnesses_ __________ _ _ ____ _ _ _ _____________
Undertaker v,�, ...,
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Fees Paid
_______
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DESCRIPTION WHEN UNKNOWN
Height
Nose_
Weight
_____ _
Hair
_ ____
_
Eyes
__
Beard
__ ___
_
Chin___ _ _ __
Neck
Teeth
_______
Mustache
____ ______________
Scars, Marks, De�r1nit ies, Et�,--------------·--- ------------
Clothing
--·
-
Contents of Pockets, Etc.,
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----
Remarks:
_
____ __
____
--------
------
VE RDICT:
___________________
_
Signed
Coroner.