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<br /> STATE 01 NEBRASKA •K
<br /> I. PLACE OF DEATH Flaws of H«kt—DMdoe et vita wlkdas ',K.IitSI !$i- ?k
<br /> °°sat, 1? i CEIPFICAnn IF IEATI ' A-1741{} 1
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<br /> /� .�J �'� ° H wemred m.106.1
<br /> City antr d..i alma No.2I.4tfitA..P1 ..M. {I riot Etna numhar. '
<br /> Length a reaidens*tg olty or town loban deaath hooccurrd.•.,yr mo....da.lbw long In v./,H a foreign Mrt.....Yrt....ao..-..db. I .-€:.
<br /> 3. FULL xAYR Fred Moyer! eH+n.'Kf.7T - "(i 1 '
<br /> Re,la.nm 22nd and St. an.2Qad :Ceran l...�Alsi d, YOUR..
<br /> ,f. SEX e.COLOR or RA e. Big(Wrta the word) Iw .:l .1..„4„1
<br /> W ri. DATE OF DEATH 2.-e- - ]f -..,
<br /> Male I White I DWivo°'nedi°Married I ORRTIFV I frS ,I
<br /> If rloof (dewed or dimmed o . ..,. to I +,,
<br /> I RUSHANU of r r th
<br /> a•,FE a Naida Alford 1 Wt sow hq�yee? on. . - "Ueath m said' in ',y
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<br /> e DATE OF BIRTH 930.)Aug. (day) l0 (Yr.) ,ap m nave eocaerw eau=Ne a.te aDoe.,at•/� • Y.
<br /> la[p order of onset eau=a duth and rol tat ea\W a Ina In J ve
<br /> i T. Age Teen Months - Days H less than t day old a onset wen u follows: 1 tbr„
<br /> 1
<br /> 11 I 10 Hr......or Mb..... J1 j;&� 1 ',µ`t
<br /> . . Trade, profession. or particular 1 __ ._.._—_— t`
<br /> z:' kind or work acne.03 epitome.$aleemaA
<br /> t G sawyer,bookkeeper,H0. ...__.__—_.__
<br /> P J. Industry or business In --M
<br /> .hies —_. —._.
<br /> work tau done, u silk m111. ...._... _— :�3'^�
<br /> 'j saw mill.Dank.etc. '
<br /> 1V 10. Dated a..adl�W,tt worked at II. Total time(years) -- --_--- - - --•_.._..._._...__._
<br /> 8 )thir) x ititztmoom and o,,a4:4uonn..J,O.. - ;-.. - -----.-._— ---..--
<br /> CoMrlbut. gases Imlwrtaooe not related to principal mom*: -
<br /> City or town.A7CLcsd p. rr 1:
<br /> :u. 8,,,,,,,,.. .na Mioh
<br /> State or eosin sees_._. �
<br /> to . ._._sees. ..---._.....------
<br /> N.me or rather 813ae Wright Azford
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<br /> R.!..,, Blob npl e.1 city or town.A.xf.Ox'dg _ `,1
<br /> E Father °° M Ch. Name of operation ma a ._
<br /> _ _ _ Stela or country 1 ".hot■ t roof)11114i Ala ..a1.• Waa the an•utopq. .
<br /> i Malden name of Mother Adelia Moyers rt If death wee due to external mu...(vlotenee)RS la.1•o tb.
<br /> e Hirthpla 4city or town Alford, r"mica°g �
<br /> r a } Accident. Icide.or homicide, hats a Injury la....
<br /> Motherm 1,tat aprcoun[ry Mioh. Where did injury occur, )'"-
<br /> lr� (Specify city or town,county,..Sta e? ! t-:
<br /> 1: INFORMANT x4..8....Fred.A.>;tord `peclfy whether In Jury oeeurea In Inauetry.In hom.,or In ualc lac. y
<br /> (Addre=) (Stand Tal a la �r. .11:,nnrr of iyary y'.
<br /> lc BURIAL.CREMATION,OR REMOV Nature i.1 lujury
<br /> torn Grand. zalana r.a....7122/30..
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<br /> ♦ e_' '- — M. Was disease or injury In any way related to occopatbn a
<br /> lr I'NDERTAEEJ' dc,s. A Ji1,C4.21g ton deceeaNtr/.V.4fY� I -y".
<br /> rte,,,t. •'•C Y If so specify... ,/
<br /> (Address) _Cr.,. (�t.....4 ,1- , �.-/ _ 1 �7F
<br /> I.. {ryyp rF CC�_y. saes )
<br /> 9 ,lx.ol.er:. twa. .�,
<br /> THIS 0 j11IES ;PIIE'Al('\4_: O BE A TRUE COPY OF AN ORIGINAL
<br /> CERTI T N F VP��Ii THE STATE DEPARTMENT OF HEALTH. F
<br /> ai,
<br /> >iUREALf`d�(•,1i• .6'1'11$3ICS, WHICH IS THE LEGAL DEPOSITORY xa
<br /> FOR VITAT,.I CORQS' 'l`:".
<br /> ....---- - 7' 'v',Q�rG/ '_'iii
<br /> DIRECTOR OF b AL � A' CS AND ASS'STANT STATE RF-I'STVAR
<br /> • LINCOLN, NEBRASKA Issued March 13, 1954
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<br /> Fred Moyers Axford
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<br /> state of Nebraska + '
<br /> C,;ur y of Hail 1
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<br /> -,, 0 , Numerical index and file0
<br /> '+: c , �_,ffIc ° cf f:egis;--- of 1
<br /> 30 day of i.%:;,.1;#
<br /> March 54 -1 E _,
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