VITAL - Death: Hank Moemberg; Washakie, Box Elder co., Utah

Transcribed & submitted by W. D. Samuelsen
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State Board of Health File No.: 22
Stamped File No.: 0400100

Place of Death: 
Precinct of: 
City, Town or Village: Washakie
Street and No.: 

Full Name of Deceased: Hank Moemberg
Former or Usual Residence: Washakie
How long resident at place of death: 
Length of residence in the city: 
Length of residence in the state: 

Sex: male
Color: red
Date of Birth: 
Age: 35y
Single, Married, Widowed or Divorced: widower
Name of Spouse: 
Birthplace: 
Name & Birthplace of Father: John Moemberg
Maiden Name & Birthplace of Mother: Pobehope
Occupation: farmer
Type of occupation: 
Date last worked: 
Total time (years) in this occupation: 
Informant & Address: George M. Ward, Washakie
Place of Burial: Washakie
Date of Burial: 28 May 1904
Undertaker & Address: 

Date of Death: 25 May 1904
Attended Date: 
Time of Death: 
Chief Cause of Death: spotted fever
Where contracted: Washakie
Duration: 
Contributory if any: 
Where Contracted: 
Duration: 
Autopsy: 
Signed: no physician
Date of Signature: 
Address: