LJ.,(.

(_
.f'IIVI t .
""· {b}Name.'.Of4h~ _place troni w~clJ,.~(!d-ysent.. . . ~M 1/Y? ~ , ~~,.. .

(c) Distance t>r"the place (r.dm_} nich body seiit. · 0 • ·~

. . . ' . . .
l~ . . · . . . . . :.
. :

2. ·The dead body brought by t,RPC ~B{lf'>tf-L <;l-iati>lfll/Vl ot,9,WJ Signature~· ~, R

3. ffte tl~ad bodf identified byJ-n 1.aj!r ;/l,fht~ 1
..!..I c., . . Signature,- ~ - · .
Rela.tionship with the deceasedL~•Wv ~,~, 01.,-.,.,,~-,v)'.

__ s-___ ~. Supfta,nc1f t acbompanying1~1?1~~ , ,. ,. ~, -~l

.. . from the eblice Officer-,o~ Magistrate, Af_
, ·· ·_-: \og;th~r \\1th
f 1. ,-- _,,, f ... {
da~e otd;I
. th~..Jmo\vli··. h
', .,. r ,j L'\ ,
·:: -"'
: Sup~s~l caus_e. of de~t. 0~ .teaSOI] \ :..r<i , ;_~
: .!!· :for1xa.iiiuatio1{ ' ' { '. '_..1 ,. :4 \_ ;-· ...' ', .-, ,t .
~:; : ,~ ~; °'-~:1~ J ·~- -l -r. ~ · :

. 6. If auto;sy. w'as' 'J'.ldt' pedonneh at1e'1-ispi~1-?. . . ·. ' .,..

(a) N~e of the place where_autorsy plft8f&~{1 i . · ;:_: ,·'1,~-,0-~ ~ 1. ._ _,n : . ' ·_.. .
r r111-ro1 e .
(b) Distan'ce;lrom lfo1pital . \ ' 1 1 _.
•. i i . • • 1 . "' -
.. ,_ ;,
1
(c) Re~son why the body was not sen~~lrelh-0spital ,.

.As•p!r_h~•.l!ihllreco~•fthe1•.~
(~) bt1te~d.mJe o~a~~ion. ·~ .~
. ~MMR;.
t ·-·~Ir
1~
c:,,h, ev-,~~ .:
(b) Date and time of death~ :i l1 f l}-
(@!)
A.\ ·'l
p J_r- I,\~
 ' \

1·

10. Condition ofbody :·Nutritional status· .

1
•• i~ !,W\v- g_ . ~cJ,..J
(Stout, moderately nourished. _e~aqiated)
warm or cold. · ·. . ~-r-_ to\~,
.. . . ' . . t \ . -~ ... _:
. 11. · -Rigor ~ms present or apsent, whether · . - /J . -
presetltin·wbbleboclyorparlo1y: , · ·..· ,· , 4,~ Jc. k
.' .• •· . ·. . ', ·5:-. ;

--
12. E:rt~ntands~s-:°fd~omposi~(3~,~esenc~t of
post mortem Uvidity on buttcks,. Joms, Back and
·- - ~~v h'~~ ~-:
, , ,, . .-~~\
- .~ ··
'J -• - . . -1r"-:,
. ,
o~ ~y.o~er ~~ifbull~elpresent the nature · ·" : ~ / ~ lafV.p~ _
1

of flmd ms1de, condition of cutic~e. , -~ . ,- . ,__ · . . ·

13. Features etc. :;. I · _ _ _ . <) _

or .o.. ll ..
.a) Whether natural swollen : .
b) State.of ey~S : (ConditiQfl o~ eyelids. · .€
.
M,.,.'tt, y ( ~. ··"·I".,., n · ·· 6r..:;)
.

conjunctivae{ cornea and lens~)- : -, __. -i _

c) Condition of lips and positiori-0ftongue.:
; ·
No ·
·•, .
C\l~1;½--1'~ . ·- (,.>',...., .. _-.J - "l--,
v)
d)-State ofnatural orip~s : _ ~- I -~ -• _m_,v,tf:, / ·
(mouth, nose, ears, vagma and anus) ~ - , 1 . ,., .~
· _ ·'. . un".e., b~
S, f .~v <'.im~ = . .
&
_ .
11
·~
V\f''-'q~
14. Condition ofskin :- , ;.. . • 1,,ig U, ii,.}) y~'
1
1 -f-rtvri +,_
a) dThedd
presence
. or absence
. of cutis
. ans~rina, b~cb.ip:g,
~M:kse:::oo:·~tc:
-1 - Y"('\.,
I _, . . ..

i : _· ,_ ·:,, . _: - _. . . -_ . . . • tJoV ·: 11-h

_ ~"''q,4,I -~.
C) Presence or absence of sand or mud on skin of hands. ; : . . \
feet or body. · · ! ·

15. Injuries to external g~nitals,' indication)dfputging :

t<-.. • ; r, . . ..-
'
 .
~'3/ ~
. .

Postmortem Number 'I_

j
"1 . . i.__,_'
r •

; :· .. •;

16. ;·--In suspected drowing case condition of the hands·

and fingers, presence or absence ofsand or earth . 1'I ()V 7u ·. ·. ·
matter within the nails or on the Jthands
iuid feet

(3)
 ',· d),,.Right
I
. ,
, ,/. -lung_::.
....,
, ,
i -
·: . wt.............................
•
.
~-:sro Oms '
, . . -•~o
•
, ..
•
·i · - : , 4 : ..
k:t II '•, ·•.,' •I .
·r ·
, .- -
·-, .
, . · •,
(·, 1- • /'
~;,i, ;-:._~.:....._; ·:} Y\f

. .~) ~~ft lung=~~· :..........:............ :.r Gins _1

. '·. ·•• i' ."- • ' r
". _
\ ·\ .'
l
·.-
..
. . ..
_

-- ~ -
/

.: .
• 1 _.
 Postmortem Number

21. ,J hdomen
a) Wall:
, b) Peritoneum :
c) Cavity:
d) Oesophagus : Pf..U..
e) Stomach and its contents with condition of walls. _· ~,r11 I1
Nb l'A,,u.,.'/tc
f HQ.
&vndl

· f) · Small intestine and its contents with condition of walls \

. . . .
g) Large intestine and its contents with condition of walls
\rt") '11A >"'
r;::::
l ,h)- Liver: wt :..... ;.. J~JP. ...............Gms · f
•
• \ I , .~ • _ • . \ •, f'lt

i)\ . Gab bladder-

\ .I \ . , . ;_
. J·) · Sp leen, .· ·wt .............. :·.... .,.1..t. O ,.•.•' --· 1
............ Gtiis.
\

· m) , .Suprarenal :
. . :: .. ,·, ,.• . '

'l ·· ·n) 'v:} . .· · .

. ;

Organs of generation : . riJf)

·,:-·. , ., . ',, .. ,, ,: . 1; , .-. 'l 1'•":J • •;$ i'-' , : _,.J. .(r-i ' .. ., · ' .

.,., ,( ,. ,;'~.U~;~bla~i::.\li~ .~. ,~ f y l . J ( ,1-~ , ., ,t l • ;. .;..· '"i I

· , , ·. <" Additional remarks , (From !!te statci<)f contents of r... b .kwr- .

· .,, '" ·-,•~ the sio'nfooh!1t'poss161e nrenaon lime·oitfealh in · ,:n~ _, ei,,.,
. . . . . I
relation :to last meal) · '
State which viscera have been retained for Chemical/Histopathological/other e)_{amination
Yes/No (a) Stomach with contents ·
Yes/No (b) Piece.of-small intestin~ ~th contents
· Yes/No (c) Piece of Liver
. . YJ&tNo ·c . (<ilH~,ne kidner~ of each
· 1.1: 1: iYe~o , .i f""\~pleen-
. • ri\'11 ., tt«-1 ·1
Yes/No l-.)) Blood
+.··o . .
. ·.-: ;Ye~ '1 r~
. .other
 /

post mortem fa nature. · !,- , ,/ : • .

1
B) The approximate time sinceldeath i,,, Ih-i ·~ . ·}-ft i's n, . ¼ / 'J/~ I
/ _ . _ 1·itr~ ._
C) cau>e of death in ~sere is ,(,.,...._ +, . _!' /<s- '1,-(:J,,. I f- 'l
. .· /Jtfle_ ')t"-,1 £9; ~ ? •. -.- ·-.- -

Date: . U-1/
~~It
MEb'ICALOFF-lCSR ~ e
~i~ture/s
CB~.
}:~/:1~ -..
MOHl'l lLIYAS'SHEIKH
FORENS1C MEDICINE & TOXIC0~~3& . • ·PROFESSORE.& HEAD··
. ·SMIMER, OPPOSft'E 1 MARKEi4'. ~UAAi-iu. FoiJ~s1c MEDICINE &·i0x1cotOGY ·
. / SMIMER, OPPOSITE BOMBAY MARKET, SURAT-I!

RECEIPT FROM ACCOMPANYING PQL_ICE ·

Received after ~ortem exmtjmation : ,..{), ~'I C>t l.l r. (J'lf t (, ••, G" < ...-, t 'J'l;U~
. .• I. \.- \ .. · . ,. ~; . . .l · . .. . . . . .

Dead body of the deceased : 1 ,Ul,a-ei~·, ~$ ..,r,11 tff:t, , c-,Je.1 f, ifi3. ~t,~
\ Clothes oilier
\ · inquest':
.I ;•
t C,.\lp . 1'1N • ~. "t .i l ;l,f l"1> ii ... h~ ~' .
Belonging as per inquest :

. Sealed bottle/s :

Sealed envelop/s : ' .

·. ~ -o,A-P .
Signature/s . _. . · · -0
Name ~tJ1H/.~~111 p,
Buccal number . 2rf3 ·.
Police station ~ -" n. fl ps¾ •
9w:t C!J
1
(6)

I I