511 / 1028
P. M.
�
Days
...il(rutnu <Unuut y Qinrnurr�
s
®ffirr...
Inquest No,_���,;r1-
<----
.
. -
1
&:i
J
,
194'
_A.
M.
_
P. M.
Name
.F�l.'""=--fL-'--
Residence
l__:J_
't ��
b'VV1[.
�JU�
·
v, IA¥
Days
White-�d-Male-Female.
J\ge
'.:i.
7
Years
�
-<
(C)
.
How long in County?
______
_
Nativity
�farried-�-Wi.QQ__w-Wiaow@r.
Occupation
�\
}lA
e_
cf....
�
.,
� LJ
..L.,
..._
,,,1�
�
/
Father's Name � Mother's Name
I
f
k"C
h
·,,L.J.
1
J)I�
Estate
Next Friend
Q
a
Place of Death�
°Y'I\
'1h
F-
Date of Death
I :
3
I
Body Found
•
,
�
-
_
!.-
-,-
Place of Accident�
iJ
oo<tL-Wctdh
-
,
�
!
�
�
Qd_
!
)
f
d �--
�
I
.P.,v,__
J
.
O::w1Q><l
Nature Injuries�
�
,
i=
c5f"rQc1,,aa} �
Cause of Death·
___
____,_t
.,_
t
____
_1.
_______________
-f.1-
-
-
-
-
-
--
�
'--
--
-
Post Mo rtem
___________�-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
- -
--
--
Names of Jurymen___ _ _ _ ___________________________�
Names of Witnesses__ __________________________________
.______J_
-
-�
-
-
--
-
-
--ti;-
-�
-;-
�
D
u
-
uc:t
II
Undertaker
(
cl
..
,. ....
·
,
.___
1
L
'-t \/�·
Fees Paid
(
_j
DESCRIPTION WHEN UNKNOWN
Height
__
_
Weig}:it
______
_
Hair
_______
Eyes
______
_
Nose
____ __
_
Chin_ ______
Neck
_ __ _ __
Teeth
_ ____
Beard
___
_
Mustache
_ _ _ __ ________
__,__
Scars, Marks, Defur1nities, Etc.,
____________ _ _ _ _____________
_
...
Clothing
--
- -
-
--
-
-
-
-
-
-
-
-
----
Con�nts of Pocke�, Ett.,
__ _ __________________________
_
Remarks:
_____
_
----- - - ----- - - - --------
VE RDICT:
_ __ _
_____
____________
_
Signed
f
Coroner.