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Inquest No.
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'Jyf
,
19�,
_ _
A. M.
_
P. M
.
Name
Residence
--
Days
Father's Name
Mother's Name
__
_
_
____________
Estate
¥
Next Friend
l'lacc of Death
J:i.5a�
Date of Death
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.:?
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/
Body Found
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lace of Accident
Nature Injuries
________ ___ _
l'ost Mortem
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Cause of Death
�ames of Jurymen
__________________________
__,_______
Names of Witnesses_________ _ _________________________
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Uudcrtaker
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Fees Paid
_______
_
Height
Nose
Beard
DESCRIPTION WHEN UNKNOWN
Weight
_ _____
Hair
___ _ _ __
Eyes
Chin________
Neck
_ _ __
_
Teeth
_ ___ _
Mustache
_______ _ _ ________
_
Scars, Marks, De�rmities, Etc.,_
_____
___
_
_ _
_
___
_
_
_ _______
_
_
___
Clothing
--
---
-
-
----
-
-
-
--- =
=
=
Contents of Pockets, Etc.,
_ _
_
_
_
_
_
_
__
---
- -
--
Remarks:
_
_
___
_
_
_ _ _ ___
_
_
_
__ _
_
_
_
_
_
_
_
_
_
_
_________
VE RDICT:
__
____
_
_
_ ___
_
___
_
__
_
_
_
_ _
__
_
_ _ _
_ __
_
Signed
Corone�