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Inquest
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Received Notice
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A. M.
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P. M.
Nam
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R,sid,nce l
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Whitc-&,nm,d-Male Female. Age
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ivears
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Months
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Days
Nati\·ity
Married Siagle
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ong m County
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Name
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Occupation
_ _ _ _____ _ _ _ ______
Estate
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Mother's Name
____ _ ________
Next Friend
_______ ______
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Place of Death
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Date of Death
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Body Found_��-�(/ _________ _ ______ _ _ ___
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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--
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i\ames of Jurymen
_ __ _ _ ______ _ _ __ _________________
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�arnes of Witnesses
__________________________ _ _ _____
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Undertaker
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Fees Paid
_______
_
Height
_
Nose_
Beard
DESCRIPTION WHEN UNKNOWN
Weight
______
_
Hair
_ _____
_
Eyes
_ ____
_
Chin_ ______
Neck
____
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Teeth
_____
_
11:ustache
_
_
____
_
__
____
__
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Scars, Marks, Defur1nities, Etc.,
_________ _ _ ___________________
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Clothing
Contents of Pockets, Etc·
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-----
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Remarks:
______
_
VERDICT:
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Signed
Coroner.