Certificate of Vital Record
Oregon State Health Division

Full Name: Harriet Simer
Residence: 3102 N Fourth, LaGrande, Union, Oregon
Marital Status: Widowed
Name of Husband: Simer
Date of Birth: February 14
Age: 83 years, 5 months, 28 days
Birthplace: Arkansas
Father's Name: ? Horn
Father's Birthplace: Unknown
Mother's Maiden Name: Unknown
Mother's Birthplace: Unknown
Date of Death: August 11, 1933
Principal Cause of Death: Uremia
Contributory Causes: Hypertension, Chronic Nephritis, Cardiac Decompensation
Informant: Mrs. Burleigh Bloom, La Grande, Oregon
Burial: Island City, Oregon