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P. 1\1.
• Inquest No.
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Days
�an1t·
Residence
White --�1-Ma1e-�le. Age
t,,I
O
Years
Months
Days
Xativity
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� long in County?
_ _ _ __
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W
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Occupation
tY�·
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Mother's Jame
_
__
_
___ _ _ __ __
Father's Name___________ __
Estate
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Next Friend
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Placc of Death
2/]��
J�ate of Death �
.2f,
/
<j',/
Body Found
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=
-
-
-
-
-
---,-1
- --
-
-
-
--
- -
-
----
!'lace of Accident
Nature Injuries
__
_ ___
__
_
_
_ ___
_
_
_
_
__
_
_
_ _
__
_
__
____
_
_
_
Cause or Death
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Post Mortem
--
-
--
-
-
------- --
-
-
--
-
--
--- --
--
-
-
---
---
l\'ames of Jurymen
___________________ _ _ _
._____________
>:ames of Witnesses
______ ______________________________
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lT11clertaker
���
,__
r'4-_
.
""'f-- - ----
Fees Paid
________
_
I!eight
Nose
Beard
DESCRIPTION WHEN UNKNOWN
Weight
____ _
_
Hair
________
Eyes
_ _ ____
Chin_____ _ _
Neck
_______
Teeth
_ ___
_
Mustache
-
--
- - ---
-
---
------
Scars, Marks, De�r1nities, Etc.,
_
__
_
___
_
___
__
_ __
_
_
_
___
_
_
_
__
__
_
Clothing
-
----
-
- -
--
-
-
-
- -
--
-
Contents of Pockets, Etc.,
__ _
•
Remarks:
_
__
_
__
_
____
__
__
_
_
__
___
_
___
--=--_____ _.:._�---
VERDICT:
Signed
Coroner: