| INQUISITION WITH JURY |
| (Section 16) |
| SAINT LUCIA. |
| District of ..................................................................................................... |
| An inquisition found at ............................................................ in the district of ............................................................ on the ............. day of ........................., 200 ........, (or by adjournment on the ............... day of ..................................., 200 .........) before me and the following jurors: |
| 1 ..................................................................................................................... |
| 2 ..................................................................................................................... |
| 3 ..................................................................................................................... |
| 4 ..................................................................................................................... |
| 5 ..................................................................................................................... |
| 6 ..................................................................................................................... |
| 7 ..................................................................................................................... |
| having inquired into when, where and after what manner .............................................. came to his/her death, do say that (here state fully the finding of the coroner and jury) ....................................................... |
| ..................................................................................................................... |
| ..................................................................................................................... |
| ..................................................................................................................... |
| ..................................................................................................................... |
| ..................................................................................................................... |
| And the jurors as mentioned above, do further say that the |
| said ................................................................, at the time of his/her death was male/female person of the age of ................. years and residing at ............................................... district of ............................................. Saint Lucia. |
| In witness whereof, the Coroner and the jurors as mentioned above, set our |
| hands the .......................... day of ............................................................................. 200 .......... |
| (Signed) ........................................................ Coroner |
| ........................................................ Foreman |
| ........................................................ Member |
| ........................................................ Member |
| .........................................................Member |
| .........................................................Member |
| ........................................................ Member |
| ........................................................ Member |
| ........................................................ Member |