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Inquest No.
_
Namt�
OJ\.\.{
Residence \
White-C,Olgrea- Ms.1@, F��le. A�e
� Years
Y Months
2.
_
Days
�ativity
(iJ
-d'r
J�
How long in County?
______
_
ed-Single-WY.v.J-
v-; r:_.
: � �
Occu t ion
___
�F---____,,,____
__,___�---
Father's Name:JhAifJ /ft _
f1u,h,yo-.
Mother's Name
�::s
=TTIHrt<
Estate
Next Friend
_____
�
----._--1---- ------
Place of Death
----,-
-
-
-
- -
-
--
--
-
Date of Death
____:___________
Body Fonnd
____,_
1
___
_
i
Place of AccideI}'t
I /I
"Xl
Canse of
A
2nd�
�ames of Jurymen
lfYl
·� \ J
7
�uv
,-........._
!
Names of Witnesses
------ ------------------------.,------
U11dertaker
r�
�1/\.4�.,- ·
Height
Nose_
Beard
TION WHEN UNKNOWN
Weight
____ _
_
Chin
________
Hair
____ __
_
Eyes.
_
_
___
Neck
Teeth.
_______
_
Mustache.
_
_
_ ___ _____
____
Scar� Matks, Defurmities, Etc.,
_______________________________
_
Clothing
_ _
Contents of Pockets, Etc.,
_.
_
_____
_
__
_
___ _ _
_
___ _
__
_
_
Re � a �
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VF.R�ICTC
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Signed
-.
_
Coroner.