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Age
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Days
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Next Friend
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Date of Death
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Body Found
Place of Accident
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Names of Jurymen
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DESCRIPTION WHEN UNKNOWN
Weight
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Hair
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Eyes.
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Neck
Teeth.
_______
Mustache
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Scars, Marks, De�r1nities, Et�,------ - ---- ------------------
Clothing
--
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Contents of Pockets, Etc.,
_ _ __ __._:. _
Remarks:
__
______
_
_
_
____ _
VERDICT:
__
_
Signed
Coroner.