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<br /> rxs eucuanMe co.-7606
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<br /> � AFFIDAVIT ��
<br /> STATE OF NEBRASKA ) V�illiain Stoeger o� lawful age, being first duly sworn, on his oath-�say�:
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<br /> ' COUNTY OF HALL ) That he is a brother of Ad.�,m Stoeger, �vho on September ��� 1932 deeded '
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<br /> the NE� oP 22�-12-12 in Hall Co. Nebraska to the sald aPfiant, signing the deed as a single man,
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<br /> ,Affiant further says that on September F�'� 1932 the said Adam Stoe��r was in fact a single man,
<br /> ', his wife Sarah S.Stoeger having passed away on November 5� 193z. and further affiant aaith not.
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<br /> William Stoeger
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<br /> I �� t i 2 aa oP �a 1 6.
<br /> Sub�cribed in my presence and aworn to befare me h s 7 y y, 93
<br /> G.C.Raven ;
<br /> (�A�,) Notary Public
<br /> Commission expires July 27, 19��. � 3 -
<br /> �' Filed for record this lst day of June, 1936, at 9:30 o�clock A.�. (J(/u��,�-��
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<br /> : Reglster of Deeda �
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<br /> " CERTIFICATE:
<br /> DEPART�SE�'T {�F HEALTH
<br /> '� 1.PLACE OF DEATH Division of Vital Statistics 21296
<br /> County Douglas City of Omaha,Nebraska
<br /> City Omaha_ Ido.2��6 Street �hitmore Length of residence in citq or �own Where death occured ii
<br /> � 17yr. mo. da. Ho� lon� in U.S.if of foreign birth yr. mo. da.
<br /> 2. FULL NAME �ary Frances Sim�son ''
<br /> ' �esidence 2��6 �iitmore ''
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<br /> ' PE�?.SONAL AND 9TATI9TICAL PARTICULARS i
<br /> . Sea �em e . Color or Ra.ce t�h te . 91ngle wr te he word Marr e �! owe W do�e Div�rd�ed
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<br /> '; 5a. If married,wid.owed or divorced Hueband of or t�ife of Thomas C. (deceased) � �
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<br /> 6. Date of Birth (mo) 6 (ctay) 2 (yea,r) 1�55 `'
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<br /> ii 7. Age Years �0 Monthe 11 Days 4 If Iess than l day Hrs or Min i�
<br /> '' , �. Tr�de,profession or particulsr kind o� work done,as spin�.':er,sav�yer,bookkeeper,etc. At hom�i
<br /> 9. Tndustry or business in which work was done,as silk mill,saw mill,bank,etc. _
<br /> 10. �ate deceased last worked at this ocoupation (month and year) �
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<br /> ' 0 11. Total time (year a) spent in this occupation ;i
<br /> ; 12. Birthplace (City or Town e►nd 8tat� or Country Illinois '
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<br /> '' 13. Name of �'sth er Rob er t �irkmsri .
<br />� ' 14. Birthplace of Father ( City or Town and State or Country E�igland
<br /> 15. Maiden name of �other �ophronia Eby �'
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<br /> 16.Birthpls�ce of �dother ( City or Town and State or Country Don�t know !±
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<br /> ' 17. Informant (Addreas) Merle M.9impson Omaha,Nebr. ' �
<br /> ' l�. Burial,cremativn or removal Plaoe Stramsburg,Nebr. Date 5-7 1936 �'
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<br /> �� 19. Undertaker (Address) Hoffmann ,Mortuary Omaha,Nebr. ;;
<br /> 20. Filed �j-7 1936 John D. Thompson Registrar
<br /> MEDI�AL CEf�TIFI CATE OF DEATH � �
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<br /> ' 21.Date of Death �ay 6 1936 � ` � ;;
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<br /> 22. I hereby eertify,Thgt I attended deeeased from Sept.1920 to May 6 1936 I laet saW her alive ';
<br /> on �tay 6 1936 death is said to have oceured on the date stated above,a�t D�idnight M. The !�
<br /> principal cause of death and related caused of importan�e ia order of on�set were ae follows:�;
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<br /> ,� Chronic �yocarditie Date of Onset 1920.� � ';
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<br /> ,` Contributory causes of importance �not related to principal cause: Chroni.c Nephritis jj
<br /> ,� �ame of operation Date of �Fhat test confirmed die,�nosis:? Clinical �as �here an autopep� l�c�
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<br /> :� 2�. If death was due to external causes (violence) fill in also the following, ji
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<br />', i; Accident ,suieide ,or homicide� Date of injury 19 t�here did in�ury occur�' (Sp�oify oity �;
<br /> ii ��,�;e��,o���d�.����..���:.-�"�`�- I� .
<br /> � or to�vn,eounty and state)� anner of injury Nature of injury _ i;
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<br />� �' 24. Was di sea,pe or in�ury in any waq related to oecupation of deceased� i�o If so,speeify
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<br /> '�� Signed) �Pilliam J.Nolax� M-�� i�
<br /> 'i � �Address) 203 Baldrige Bldg. ''
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<br /> ;; I 3�ereby certify that the above is a true and corr�ct copy of the certificate of death recorded �;
<br /> �� in the City of Omaha,,County of Douglas,State of �tebraska. John D. Thompson Re istra� �;
<br /> �� Dated this 25th day of �ay 1936 (SEAL) �'G�� � i; �-
<br /> !� Filed for record this 1 day of June,1936,at 1 o�clock P.�4. � e� s er o e s �'
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