560 / 1028
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===
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101
=
-
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Notice�/
'l
Residence '-"lJl::a ,..,S!-:U-4.
ALUecrn�
_
,
19
.3J
,
__
A. M.
P. M
L2_Years
____
Months
-------''------
Days
Nativity
____ ____________ __
_
How long in County?
__
_
M�-Single-
'W.id.ow-\Vi'ao'wer.
Occupation
_
_ _
_
_
__
_
__
_
_
_
_
_
__
__
Father's Name______________
Mother's Name
_
_
__
____
_
_
__
__
_
Estate
______________ _
�
Next Friend
______________
_
Place of Death_______________
Date of Death
__________ _
_
Body Found
______ _ ___ _____ __ _
Nature Injuries
',,!,..!
,
1
g,
l:tL1d/\ll
14-1
w ,,
Cause of Death 1-::1- ' I.A,..YLM!Ul
'I".I
v
,
\A
A
-"""_...
Post Mortem
___ _
_
___ _
__
_
_
____
Names of Jurymen
__
_
___ _ _
_____
_
__
- --'
Names of Witnesses_______________________ ___________
�
Under
.
taker�
-
� '-
Fees Paid
_ _
_
DESCRIPTION WHEN UNKNOWN
Height
____ ___
Weight
_ _____
Hair
_ _
_
Eyes
_ _
Nose _________
Chin_ ____ _
Neck_
_
Teeth
_ ____
Beard
11ustache
__ _____________
_
Scars, Marks, Deformities, Etc.,
_______ _____ _ ___ ___________
_
Clothing---------- ------
Contents of Pockets, Etc.,
__
_
_
_
_
_
_
_
__
Remarks:________________ ____________________
VE RDICT:
__________ _______________
�
Signed
Coroner.