Coroner's Book

519 / 1028

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..JKrntnn <nnunt y <nnrnnrr�!l ®ffirr....
�101 =_ =
·�)'"" ,L, 1 9� __A. M. _ P. M.
· ire-Female. Age 1a,,1 1 6o-' - _ _ _Months Days
in County?_______ _
Married-Siugle-Widow-V\Tidower. Occupation_ ___________________
Father's Name_________ _ _ _ Mother's :Name _________ _____ _
Estate :Next Friend_ _ _ __ _ _ _ ____ _
Place of Death_ _ _ _ _ __ ____ Date of Death_ _ _ _______ _ _
Body Fonnd_________________--,----_________ ____ _ _
Place of Accident
Nature Injuries_ _______ -----;-,,---------- ----- - -- --- - -
Cause of Death ���,' ; . pl'L rcA ,JJ"v��
Post Mortem _J -:--fr
I
Narues of Jurymen_ ___________________ ___ _ __ ____
Names of Witnesses_ _ _______________ _ _ :--- ---- - - ------
Undertaker C Pf?� Fees Paid________
DESCRIPTION WHEN UNKNOWN
Height Weight_ _ _ _ _ Hair_______ _ Eyes_ __
Nose_ _ _ _ _ _ _ Chin_ _ _ _ __ :Neck___ _ _ _ Teeth____ _
Beard___ _ _ _ --- -- - Mustache________________ _
Scars, Marks, De�r1nities, Etc.,________________ _____ _______
Clothing--- ----------- - - -
Contents of Pockets, Etc.,_ __ _ _____________________ __
Remarks: ____ _ _ _ __ _ _ ________________---,----- -�
VERDICT:___ _ _ _ _ _ �------ - ---------
........
Signed Coroner.