Coroner's Book

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Inquest No,___ _ _
/·�
----, 19_) /, - _A. M.
Name :1'hl\A
Residence ....., v 1 1 • , � -- � -- , v - - ,, -- x .,_.-
P. M
White-e"olored-.M.ale..-Female. Age Q....�----- ___ _ Mouths �- Days
Nativity How long in County?_ _ _
Married-�e-Witlow=:w.i� Occupation _____
Father's Name___ _ __ _ ______ Mother's Name_____ _ ________ _
E state· �� � - Next Friend
Place of Death ��- CJ Date of Death____ _ ______
Body Found ��{' ]J� � __
Place of Accident__________ _ _ _
Nature Injuries_ _________ _
Cause of Death &� ��.
Post Mortem _ __ _ _
Names of Jurymen_____ ____ _ _ _ _ _
Names of Witnesses_____ ___ _ _______________________
undertaker {A,Lfum V:fit:, ..,·v� Fees Paid ____
DESCRIPTION WHEN UNKNOWN
Height.____ _ _ Weight_______
Nose. _ ______ Chin__ _ _ ___
Hair __ Eyes_ __
Neek _ _ _ Teeth _
Beard Mustache___ _ __ ________
Scars, Marks, Deformities, Etc., ___ _ __________________________
Clothing--==----- ----- -------- - ------ ====- ----
of Pockets, Etc.,____________
Remarks:_____ ___ ___ _____________ _ _________
VERDICT: __ _
Signed Coroner.
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