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Inquest No,
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Celeres. -Male
Female.
Age
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Years
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Months
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Days
Nativity
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How long in County?
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Married
Siugle-Widow-Wido L Occupation
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Father's Name �
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Mother's Name
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Estate_______�-------
Place of Death
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Body Found
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Next Friend
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Date of Death
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Place of Accident
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Nature Injuries
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Cause of Death
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Post Mortem
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Names of Jurymen
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Names of Witnesses�· 8z
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Undertaker
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Height.
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Weight
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Nose________
Chin
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Fees Paid
__
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UNKNOWN
Hair
_
_
_
_ __
Neck
_
Eyes_
Teeth
____
Beard_________ __ _ _ _�
Mustache_____ _ _ _________
Scars, Marks, Deformities, Etc.,
_
___
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___
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_____
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____
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____
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Clothing-------- � - ------
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Contents of Pockets, Etc.,
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Remarks:
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VE RDICT:
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Signed
Coroner.
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