WHEREAS I with my Inquest have, on the Day of the Date
hereof, taken a View of the Body of
lying dead

THESE are therefore, to certify, that you may lawfully permit the
Body of the said
to be buried, and for your so doing this shall be your Warrant.
Given under my Hand and Seal this Day of

To the Minister and Churchwardens of the
Parish of
in the Ward of
and whom else these may concern.}

THOMAS SHELTON< no role >
CORONER.