564 / 1028
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Name
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Inquest No.
Receiv d
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Notice__Q_�
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19_3J,
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A. M.
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P. 11
Residence
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ars
Months
Da3,
Nativity ,� • [�
How long in County?-) _(- �.
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Father's Name
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W.e.X�W·
fother's Name
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Estate
f- �Next Friend
Plac
e
of Death
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Dat
e
of Death_a 4 /� � /
93/
Body Found
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Place of Accident
v
Cause of
Post Mortem
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Names of Jurymen
______
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Nam
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s of Witness
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s � � fuA �
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Und
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rtak
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Fees Paid.
___
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DESCRIPTION WHEN UNKNOWN
Height
_______
Weight.
_ _____
Hair
_
_
Nose:
________
Chin
_ ______
Neck
_
Eyes�
Teeth
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Beard_________________
l\t1ustache
_______________
_
Scars, l\t1arks, Deformities, Etc.,
___
__
_
_
__
_ _
_
_ __
__
_ ______
__
_
_
Clothing
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-----
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-
-
-
-
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Contents of Pockets, Etc.,
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_
__
_
__
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Remarks:
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_
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_
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_
V E RDICT:
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_
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_
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_
_
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_ _
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Signed
Coroner.