539 / 1028
. M.
Days
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Inquest No.
Received
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_
,
19$/,
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P. M.
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Residence
_
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_ _ ________ _ _ ___ ________ _ _ _
White-CcNerecl. Male-Female. Age
Years
-
�
�Y'
1
Month
s
�
Nativity
How long in County?
_
Days
�[arrie<l-Single-Widow-Widower.
Occupation
_ __
_
_____
_
_
_
____
_
_
_
_
Father's Name
Mother's Name
_____ _ _______
_
Estate
Next Friend
_ _ _ _ _ __ _____
_
BndyFound
£� � ��
eJ
-
�
Place of Death
Date of Death �
Canse of Death
_
Post Mortem
___________
_
�ames
of Jurymen
__
_ __
_
_
__
___
__
_
_
_
Names of Witnesses______ _________________ _ ___ _ ______
lJ11tlcrtaker
��
Fees Paid
_ _
DESCRIPTION WHEN
UNKNOWN
JI eight.
Weight
Hair
_ _
Eyes
Nose
Chin
Neck
_
Teeth
Beard
Mustache
St'ars, !\farks,
Deformities,
Etc.,
Clothing
---
----- -
-
-
--- -
-
=
=
-
·
Contents of Pockets, Etc.,
_ _ _______ _ ___
Remarks:
_
__
__
_
_ _
___
__
______ _ _ __ _
_
_
____
,
______
VE RVICT:
_____ ---- ----------·
Signed
Coroner.