750 / 1028
M.
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Age
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Years
Days
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Place of Death
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Date of Death
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Body Found
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Place of Accident
.,ature Injuries
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Cause of Death
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Post Mortem
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ames of Jurymen
_
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_
____
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_ _ __
Names of Witnesses
____________ _ _ ___________ _ _ ______
_
Undertaker
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Fees Paid
_ ______
_
DESCRIPTION WHEN UNKNOWN
Height
Weight
Hair
Eyes
Nose
Chin
Neck
Teeth
Beard
Mustache
Scars, Marks,
Deformities,
Etc.,
Clothing
_____ _:______
·
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Contents of Pockets, Etc.,
__
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Remarks:
__
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VERDICT:
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Signed
Coroner.