531 / 1028
P. M.
Days
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101
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Inquest
No.,_._
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, 19
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A. M.
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P. M.
Name
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Residence
White
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Months
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Days
Father's Name
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Mother's Name
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,___ _ _____
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Estate______________
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Place of Death
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Body Found
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Place of Accident
�ature Injuries,
____
_
_ _ _
_
_
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_
_ _ _ _
_____
___
_____
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Canse or Death
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Post Mortem
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--
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---
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--
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Names of Jurymen___ _ _ ______ _ _ _ ______________.________
Names of Witnesses___ _ _ ______________ ______________
Undertaker
Height
Nose
Beard
S<'arS; Marks,
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Fees Paid
___
_
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DESCRIPTION WHEN UNKNOWN
Weight
Hair
Eyes
Chin
Neck
Teeth
Mustache
Deformities,
Etc.,
Clothing
_______ _
___:__ _ ______
==--
Contents of Pockets, Etc.,
_ ____________ _____ _ _ _ _____ _
Remarks:
_
_
_
_
__
_
__
____ __ _ _
_
____
_
_
___
____
_
___
_
_
VE RDICT:
__________________ _ _
.:__ _
_
___
_ _ _
_
_ ____
_
_
_
Signed
Coroner.