472 / 1028
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Inquest No.
Received Notice
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19
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A. M.
Name
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ak.
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Residence-'
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,vd
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White-Gel.w;ed-Mat@ Female. Age
Years
_
_ _
Mouths
Nativity
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b
UtttW
How long in County?
__
_
P. M.
.
Days
�-Single-�w-W�er.
Father's Name
\,\MA<M.�
Occupation
_
_
__
__
_
_
_
_
_
_
_
_____
__
Mother's Name
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-
-
Estate
�
Place of Death
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Next Friend
________ _ ____
_
Body Found
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Date of Death �
W
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l
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J
Place of Accident
____________ _______ _
_
Nature Injuries
_
_
_
_
_ _ _ _
_
_
_
_
_
_ _
_
_
_
_
_ _ _
__
_
_ _
__
Cause of Death
________________________________�
Post Mortem
__
--- - - -- - ------------------------ - - --
- -- -
Names of Jurymen
__
____
_
_ _ _
__
_
_
_______
___
_______
_
Names of Witnesses__________ _ _ __ __________________
Undertaker ���
Fees Paid.
____
_
DESCRIPTION WHEN UNKNOWN
Height
Weight
Hair
-·
-
Eyes
Nose
Chin
Neck
Teeth
Beard
Mustache
Scars,
Marks,
.
Deformities,
Etc.,
Clothing
-
-
-
-
--
-
---
-
---- -
Contents of Pockets, Etc.,
________________
_
Remarks:______ ______ _ _____ ___ ______ ________
VE RDICT:
_ _________________ _ ____________
_
Signed
Coroner.
•
I
Inq
Na1
Re
\Vh
Nat
Mar
Fat
Est
Pia
Bod
Nat
Can
.
,
Pos
Nan
Nan
lJ 11cl
Hei
Nos
Bear
Scan
Clotl
Cont
Rem
VER