Coroner's Book

513 / 1028

P. M.
Days
...il(rutnn <tTnunty <tTnrnnrr� ll ®ffirr...
===�101===
Inquest No. Received Notice� 3 , 19.J I, __ A. M. _ _ P. M.
Name ,�� �� )
Residence #-' Q (J rf St,� Ii · �� a}�
White-�ed-Male-�le. Age §/ Years Months Days
Nativity How long in County?_ _ ____
�larried-�;1,elc \TJw;1ow \.ViclouJ� Occupation______________ _ ___ _ _
Father's Name____ _ ___ _ ____ Mother's Na1ne____________ _ _
Estate Next Friend___ � ------ ---
Plaee of Death d' 3 J ,;3 • J. #. Date of Death � 5, .s 1•,ff;,.,
Body Found _,,__ , � ,, ,. ,,
Place of Accident_ _ _ __ _ _� ----- - - - - -- - - - ----- - --
Nature Injuries___.,L
Cause of Death��� I� 1)--� - 4>.�- , ,
d Post Mortem _ _ _ _ __ _
Naines of Jury1nen_ ____ __________ _ _ __: _____ _ _ ___
Names of Witnesses - ------------------------ ---------
Undertakeriln.� · ' Fees Paid __ __ _ _
DESCRIPTION WHEN UNKNOWN
Height Weight_ _ _ __ _ Hair_ ______ Eyes. __ _ _ _ _
Nose _____ _ _ Chin________ Neck Teeth_______
Beard _____ _ _ :Mustache___________ ____
Scars, Marks, Defur1nities, Etc.,________ _______ _ _ ______ _ ___
Clothing -- - -
Contents of Pockets, Etc.,__ _
--- Remarks:______ _ __ ___________________ ______
V E RDICT:_ _____________________ _ __________ ___
Signed Coroner.