Description of U.S. Indian School Land at Salem Indian School, Chemawa, Oregon, lying West of S.P.B.8. track and extending West to Oregon Electric track and bounded on the North by county Road and on the south by County Road, which is south of school cemetery: Lands bounded and described as by beginning at a point 7.82 chains t of the eent r of ec. 36 I 6 S.2. 3 W of 7 VL,, running thence South 50.06 chains alone the Seat line of the land of 3. 0. Pttgh to the North line of the Janet nation Claim; thane along ;he said North line of the Janet Pugh Donation Claim 27*22 cba5 or lass to the center of the track of the 0. and C.R.R. ace in a North itiasterly dirc- tion along the center of said 0. and C.R.R. track to the Korth Boundary line of the S.S. 1/4 of Sec. 36 T. 6 S. fi. 3 W of W. M.J thaace West along the North line of the S of said See. 36 to the place of beginning containing 177.32 acr 8 ?iore or less. Vol. 33 Page; 184 Marion County Record PURCHASEDJ April 21, 1885 1.0. Misc. Deed Book 6 Page 506 CILidj 11 k, /.- * Description of U.S. Indian School lend at Salem Indian School, Chemawa, Oregon, lying 3aat of M4 running parallel to the S.P.R.R., running from south limits of school property and running north Market road north of school hospital: Land in Sec. 31 of T. 6 S. R. 8W., and Sac. 96 of T. 6 S.R. S W. , M.M., bounded and described in the center of the 0. and C.R.R. track on the North boundry of said land in Sac. 36 T 6 S.R. S 1 of l.M., at a eonrner where la driven iron bar, 18 inches long by 5/8 x l inches from which a fir 16 inches la diameter bears 3 70 1/4 degrees W 165 links distant, thence 1 3.91 chains to the quarter section corner on the ran e line between Sec. 31 of T. 6 c. 2 ., and *e. 36 of T 6 S.R. 3 W; Thence list 6.64 chains to the KI eonrner of what is known as th Moores land; where Is set a post from which is a fir 15 inches in diameter bears S 82 S 40 links distant and a fir 28 inches in diameter bears H 82 W 65 links distant; thence South 8.80 chains to the HW eonrner teener of the W.B.Stephen Donation Claim* Thence 8* 41.04 chains to the 3.7. corner of the W. B. Stephen Donation Claim; thence south to the SB corner of what is known ae the Moores land and on the line of the Janet Pugh Donation Claim where ia set a post from which a fir 15 inches* in diameter bears 26 E 109 links distant and a fir 6 inches in diameter bears N 77 3/4 egre* 48 links distant; thence W on the 3 boundary of said land 27.30 chains to the center of the 0 and C.R.R. track where is driven an iron bar 18 inches long by 5/8 x l r inches, at a corner on said track, from which a fir 26 inches in diameter bears H 86 1/2 degrees S 102 like distant and a fir 20 inches in diameter bears H 75 degrees 50 niautes W 80 links distant; thence H 18 1/2 2 along the R.R. track 52.82 chains to the place of beginning. Vol. 35 Page 238 Marion County Records April 29, 1887 I.O.Mlac. Record Book Bo. 2 - Page 128 Authority Harcb 2, 1887 (2ft Stat. 465) CBL:dj Description of 1*. S. Indian School lent, at Salem Indian School, Chemawa, Oregon, adjoining the Pacific Highway at what ia known as the Sllverton Chemawa, Portland Salem four corners highway. Beginning at the South-west corner of the D.L.C. of Stanford 3. Stephens and wife in 6 S.F., 27. of Willamette Meridian. Ttence Sast 2 chains to the center of the County road leading fron Salsa to Brooks, thenc aloe said road as follows: forth 180 degrees 30 minutes east eight and seventy- one hundredths (8.71) chains, north 7 degress, west 16.84 to the canter of the Lake Labieh- Drainage Ditch, thence sooth 33 degrees, 30 minutes. West 4.11 chalne, thence 3outh 24.43 chains to tha Worth line of the D.L.C. of at. B. Stephens thence'north 89 degrees 45 minutes, last 1.31 chains-to the point-of.beginning. Containing .18.25 acres. Toi. 77 Fsge 134 Marion County Records -11 August 23, 1S00 Description of U*S, Indian School Land lying EAST of Howpital, Auditorium and Printing office and adjoining Lake LaBish; A part of the Donation Land Claim of - -tephenn and wife, Certificate Be. 2063, iBotlficatlon No. 236 in T. 6 and 7 S,, Range 2 , in rion County, Oregon, State of Oregon: Conmeneicg at the . corner of said donation land clal and running thence easterly along the S line of said claim 28.29 chains to the . . . corner of a tract heretofore deeded by the said . B. Stephens to August Manta; thence northerly along the W. line of the Mantz tract and the same extended 41.12 chains to the Worth boundary line of said of . .. tephene and wife; thence Westerly along said U. boundary line 28.29 chaina to the H. W. corner of said L.L.C.; thence Southerly along the W. boundary of aald D.L.C. 41.04 chains to the place of beginning, containing 116.74 acres of land, more or Less, - ve and except the following described land, to wit: Beginning at a ioint 14.25 chains of tDa *. . corner of the . -phens D.L.C and running thence S 9.50 chains; thence chains, thence 4.75 chains; thence C 10. ins; thence 4. ?5 chain.s, thence L 21.06 chains to the place of beginning an gt; filing 15 acres, thus leaving ,of the original tr x.74 acres, Also an easement or right of way deeded to the Lake Labials Drainage District by it. P. Boise and wife, said land being described as follows: strin of land 15 links wide on side of a center line of the following described ditch: ,i *iCi *.* -* fit en pOxQ v if the S. 7. corner of land owned by John Enlght Sec. 31 T. C arion County, Oiego running thence 3 17 s/4 tf. 1 chain, thence H.74 degrees 1. 3.00 chains, thence II. 70 degrees 4.75 chains to a point 5.90 chaina h of of land owned by solas, VOL. 110 Page 531 Marion County Record* purchased May 26, 1910. i A ea.b gg1 IS aS a lt;u l il XI5 a a DC 0) 1 si 43 Kg I' a si 0 o a I a s? i I 8?l i*-; illl o3 53 s-3 lt;* Jss 6 I fie 1. PLACE OP BIRTH vmage or Town J.uneau.,.....Alas.ka (If in remote section, give distance and direction from town) Name of hospital or institution: None (If not in hospital or institution give street number or location) Mother's stay before delivery: ... . In hospital or institution... . In this community (Specify whether years, months, or days) 2. PULL NAME OP CHILD .SX.LAS...RQY MOON Registrar's N0....155.8..8.. STANDARD CERTIFICATE OF BIRTH Territory of Alaska (If child is not yet named, make supplemental report as directed.) 3 Sex of Child Male 4 Twin or triplet or other so born 2d, or 3rd or other Single If so born 1st, Number months of pregnancy Q 5 Legitimate? Yes 6 Date of - . birth Sept...... . 83 (Month) (Day) (Year) 7 Pull Name FATHER Silas Roy Moon MOTHER j 13 Pull Maiden Name Susie Charley 8 Residence Juneau, Alaska 9 Color ., , or Race AiaSKan Native Age at last Birthday.. (years) io Birthplace Alaska 11 Occupation Flshlnff 12 Children born to this mother: How many other children of this mother are now living? .2....daught.er.s.-rrr....do....no.t...kno.w....i. living Dead 14 Residence Juneau, Alaska vh5 Color or Race Alaskan- Aeeat last Birthday.. ? Native (rears) 16 Birthplace Juneau, Alaska 17 Occupation Housekeeper 18 How many other children were born alive but are now dead? unknown Q.Mest....chl.l.cL How many children were born dead? .....UDjSXLQ.Wn 19 CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE I hereby certify that I attended the birth of this child who was born alive at the hour of 4...*... m. on the date above stated and that the information given was furnished by AB.n. ....ffl . l gt;l. .C.6 , related to this child as Aunt ker DOCTOR, MIDWIFE OR OTHER PERSON A MM A t Y WAT T APT PRESENT AT BIRTH MUST SIGN HERE BS SSSf*:... JiJL, Rftfe Mlfc . mark M. D., midwife, or M tt. J f.3L bate signedlL/.7./.4 ddress J.U.n.e.a.U.,....Ala.8.ka ite on which given name added .?./.l.(./83 By ' ness ta her mark Registrar James Lsr Ht goutL Juneau.' Aaav TOftfic 2TJ Orlg Registered No. (Commissioner's seal) in Book No. ...1 -B.. (date) Juneau Precinct, Juneau (Town) .. at Page ....181 , Division No....0ne- FELIX GRAY U. S. Commissioner. Piled in Office of Registrar of Vital Statistics JAN....12..-19-42 Juneau, Alaska. FEANK...A...B.0.YLE Registrar of Vital Statistics Neil...Moore Clerk By I hereby certify that the foregoing is a true copy of the original Certificate of Birth filed withttie Registrar of Vital Statistics for the Terrtory of Alaska. 7 Juneau, Alaska. Feb. 21, 1942 Date . WHEN THE CERTIFICATE OF BIRTH IS FILED MORE THAN SIX MONTHS AFTER THE BIRTH, THE DOCTOR, MIDWIFE OR OTHER PERSON SIGNING THIS CERTIFICATE MUST EXECUTE THE FOLLOWING AFFIDAVIT: UNITED STATES OF AMERICA I TERRITORY OF ALASKA SS' Anna.. Wallace. of ..Juneau,...A aska. after being first duly sworn, deposes and states: That .She was present at the time of the birth of ..Slla.S...Roy...Mo.Qn.... which occurred at -Juneau- , Alaska- , on 1883 Sept ember...14,, f , and personally knows the circumstances surrounding the same; that no certificate of birth was filed within six months from the date of this birth; that the purpose of this affidavit is to secure an official record of the said birth and that the statements contained in the certificat are true and correct. (State Relation to Child) Aunt witness to her mark; , her ,,., . James L. Hobgood, Juneau, Aaa. MM 1X1 WALLACE Luella M. King, Juneau, Aaa. . qPvpntVi maris; Subscribed ana sworn to before me this .r. ?J..r.**.r.S day of November ,19.4.1.. (Notarial seal) .JA .E.S...L ..HP.?.Q P?.?.... Notary Public for Alaska. My commission expires 3.e.p.t.......9. gt; 194.4 UNITED STATES OF AMERICA TERRITORY OF ALASKA JSS- .Jimmy...Fpx of and Jlmmle... Jack of after being first duly sworn, depose and state: That they have read the certificate of birth of ......-. A M...1:.?.?...M0.?.?. J.un.e.a.u.,...Alas.ka. Juneau., Alaska- and were present in the community at the time of the birth and know the circumstances thereof and know that the statements contained on said certificate are true and correct. JAMES..FOX ,.,.,- JIMMIE JACK Subscribed and sworn to before me this ...8-th day of -Ho-V-em-her- , 19..41. ; 57.MES..L....HO;Bap OD Notary Public for Alaska. My commission expires ...SejD.t......9., 184.4 IF ADDITIONAL SPACE IS NEEDED FOR AFFIDAVITS, ATTACH SAME TO THIS FORM. (Notarial seal) 333 M. W. 6th Avunufl Portland, Oregon June 24, 1941 Mr. Johnny Harris Juneau, Alaska Dear Johnnys In a good many oases it is necessary to have proof of citizenship before work can be obtained in this locality and X am trying to get a copy of ay birth certificate or an affidavit showing that 1 was born in Juneau. I wrote to the Juneau Indian Office today and requested that they send as a statement certifying to my enrollment with the Indian Service, if such a record is on file. I wonder if you would contact the Indian Office and see if they have any such record of me. They might overlook my request or neglect to take care of this matter, and I thought that if you -would look into it for me I might get better action from them. Also, will you call at the Court House and see if there is a record on file there of my adoption by Missionary Charles Reprogale? The adoption record would probably give my birth place and birth date. If a copy of the adoption record can be obtained or an affidavit based on that record, It might serve to prove my citizenship. Anything you can do to help me in this matter will be appreciated very much. Yours very truly, Silas Moon p Ind. iimp. 434 Federal 0 ourthouse Building Portland, Oregon June 24, 1941 Mr. Claude M. Hirst, General Superintendent Office of Indian Affairs, Juneau, Alaska Dear Mr. Hirst: Us have had a request today from Mr. Silas Moon, an Alaskan Indian, for a copy of his birth certificate or a record of his enrollment which might serve to prove his citiaenship. Mr. Moon is 1/2 degree Ihlinget Indian and was born in Juneau on or about September 14, 1884. His mother's maiden name was Susie Charley, hen Mr. Moon was about ten years old he was adopted by a raisabnary by the nana of Charles progale and he believes that a record of this adoption is on file in the County Court House. At the age of 12 years he came to the States and was enrolled at the Chemawa School. If you can provide Mr. Moon with a statement certifying to his enrollment, degree of Indian blood, and placeof birth, it will be appreciated vmry much. Any information which you may send to this office regarding Mr. Moon will be delivered to him. Thank you for your assistance in this matter. lours truly, R. Abeita, Asst. Guidance k Placement Officer SILAS ROY MOON Place of death: County- Clatsop Lower Nehalsm District, rural Social Security Ho. 543-01-782 Sex- Lale Alaskan Indian Divorced Birth date- Sept.18, 1683 Age 63 years 1 day. Birth place- Juneau, Alaska Usual occupation- Head loader Father or mother- no record Informant's own signature- Charles . Larsen Burial- Sept. 25, 194o Place- Oceanview Cemetary- Astoria, Oregon Signature of funeral director- Ruth Ginn Address 631 Franklin avs.,Astoria, Oregon MEDICAL CERTIFICATION Date of death- Sept. 19, 1946 i'iuie 9:30 A.M. Immediate cause of death: crushed chest and abdomen Accident, suicide, or homicide specify) Accident Date of occurence Al'sie, rural, olatsop Co. Where did injury occur- Xatg iagxajtmg: Sept.19, 1946 Did injury occur in or about home, on farm, in industrial place, in public place ? Logging camp. while at work ? Yes Means of injury- Run over by truck Signature- William R. Thompson, Coroner Address- .astoria, Oregon Date signed 9/E0/46 Usual Residence of deceased: State- Oregon uounty- ulatsop If foreign born, hov,? long in U.S.A. 50 years TERRITORY OF ALASKA REFERENCE ADDRESSONL, AUDITOR OF ALASKA corporate no. AUDITOR OF ALASKA INSURANCE COMMISSIONER FOR ALASKA JUNEAU. ALASKA INSURANCE NO. REGISTRAR VITAL STATISTICS FOR ALASKA JUNEAU VITAL STATISTICS . February 21, 1942 Mr. Silas Moon, Warm Springs, Oregon Re: Birth Certificate SILAS ROY MOON Dear Sir: Enclosed herewith please find a certified copy of your certificate of birth together with my official receipt for 1.00. When you wrote us on December 8, 1941 asking for this copy the certificate of your birth was not yet on file in this office. We did not receive this certificate from the United States Commissioner until the twelfth of January, Very truly yours, O LN Frank A. Boyle, Encls-2 Registrar of Vital Statistics cc to: Luella M. King, Acting Principal, Juneau-Douglas, Indian Service Schools J TERRITORY OF AL3SKA ) ss FIRST JUDICIAL DISTRICT) I, Jimmy Jack, being duly sworn depose and say that I am an uncle of Silas Moon, he being the son of my oldest sister and that I knew him as a boy and that I know that he was and is a native borned iunericanl Signed; *** B Jimmie Jack Subscribed to and sworn to before me this the third Day of September 1941 at Juneau, Alaska y 6uj- X NOTARY PUBLIC IN AND FOR ALASKA MY COMMISSION WIR S.. /J M *f TERRITORY OF ALASKA ) ) ss FIRST JUDICIAL DISTRICT) I, Jimmy Fox, being duly sworn on oath depose and say that I knew the parents of Silas Moon and that I know him to be a native borned American. I do not remember the exact date of his birth but I believe that it was about 1884. I knew him until the time that he left here as a boy. I did not know anything about him nnMmmfaani after he left here until his return here about iamm 1912, I remember him as being a good catcher on the baseball team at that time. Sugned .j ?yc gt;x Jimmy Fox Subscribed and sworn to before me this the third day of September 1941, at Juneau, Alaska i before me NOTARY PUBLIC li. . MY COMMISSION HOMES-./- '3 -V lt;-f- NOTARY PUBLIC IN ANt FOR ALASKA i TERRITORY OF AMEKA ) ) ss FIRST JUDICIAL DISTRICT) I, Anna Wallace, being duly sworn depose and say that I am about sixty years of age and that I am a younger sister of Susie Charley, mother of Silas Moon. I was present at the time of the birth of Silas Moon and I know that he was borned at Juneau, Alaska about 1885 timna and that it was in the Fall. The Father was drowned before he,Saias Moon, was borned and my sister kept Silas until after the last Potlatch up the Taku and then she gave him up to be adopted by a white man. Rev. Jonas persuaded her to give him up so he could attend school. The Father and Mother of Silas Moon were both Native Alaskians and belonged to the Thlinget Tribe. Her S igned; Anna ( gt; lt;C) Wallace Mark Witnesses to her mark and affidavit; / lt; uneau, Alaska lt;ffW /?V0S lt;ft lt;*w 0 *m gt; Alaska Subscribed and sworn to before me this the third day of September U41 at Juneau, Alaska NOTARY PUBLIC IN AND FOR ALASKA MY COMMISSION EXHRES 7-' 3- *f* I Under Wheels Of Truck Silas Roy p/loan, a native Alaskan Indian employed* as head loader by the Davis Logging company near Elsie was, killed Thursday morning at about 9:30 at the Nehalem valley camp when he was run over by a logging truck he was loading. Moon, who was 63 and reportedly hard of hearing, apparently failed to hear the heavy logging truck. The jear dual wheels of the vehicle passed over his body. * . * Loggers of the small Elsie camp wrich does sub-contract falling for the Van Vleet logging company, rushed Moon to the Seaside hospital, thinking that he was still alive. A doctor at the hospital pronounced him dead. A coroners official, who laid the cause of death to multiple internal injuries, said today that Moon died instantly or soon after the fatal accident. * * : : The driver of the truck was Roland Picard, a Van Vleet hauler. He wars in the process of backing the truck. Ginn's Funeral home, where the body was taken, and the Van Vleet logging company are attempting to locate relatives of the deceased. However it is believed that Moon ,had no family. K 3 -an t-? IGaat Mill att Skjatanrntt of ..SILA3...R.....MQ0N STATE OF OREGON, County of Multnomah J I, Al L. Brown, County Clerk, and ex-officio Recorder of Conveyances, in and for said County, do hereby certify that the within instrument of writing was received for record and recorded in the record of ...:, of said County at 0 lt;S 1946 SEr 26 AM 11 47 In Book Ml. On Page Witness my hand and seal of office affixed. L. BROWN, ounty Clerk. Deputy. Form Co. Clk.-25 Recording Certificate IjJy TT / s C JfrOKM Nn ilfr-WIIiTi. , iTiini.iBimiDi.ci.mTi.il., 3tt Nam? of lt; ob - Kmm KNOW ALL MEN, That I SILAS. R.,.. MOON,...., , , o/....Port.l Rd,. in the State of Oregon , 0f the age of Sixty. years, being of sound and disposing mind and memory, and not acting under duress, menace, fraud or undue influence of any person whomsoever, do make, publish and declare this my Last Will and Testament in manner and form following, to-wit: FIRST, It is my will, and I do order, that all my just debts and funeral expenses be duly paid and satisfied as soon as conveniently can be done after my decease. SECOND, I,give, devise and bequeath unto Ghar e ..E ...Lax. en.f...8Ji lt;l..hLs... aMght.er, Yi.Ylan..Xo.un blQM,....Q an:d...p.e:i?.aoiial.,....where.soeve.r...S-i.t.uat;.e. i..... .IHIfiD.,ujL lt; ta.. kay.e...nQ...llfteaL..aeac.en enta gt; . OAs .Jm t: AND LASTLY, I nominate, constitute and appoint .Gliar.l.e.a..E*...Lar.s.enr to be the execut.QT..... of this, my Last Witt,....T. hereby revoking all other Wills, Legacies and Bequests by me heretofore made and declaring this, and no other, to be my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this day of May.. gt; n..y.. in the year of our Lord One Thousand Nine Hundred and F.Qr.t -thr.e..e... ..... lt; (Seal) The above instrument was at the date thereof signed, sealed, published and declared, by the said J3Has...R.....M.QOn., as and for Ills. Last Will and Testament, in the presence of us, who, at h.i.8 request and m..ills presence, and in the presence of each other, have subsyribei/burtfmnefi as witnesses theveto. Residingat /. Residing at. RECEIPT Received fron the Canadian Bank of Commerce, Portland, Oregon, contents of Safe Deposit Box Mo.3218, amounting to One Hundred No/100 Dollars, rented to Silas R. MOOn, deceased. Charles E. Larsen Vivian Toungblood February 6, 1947 STATE OF OREGON, ) ) ss County of Marion, ) We, CHARLES E. LARSEN and VIVIAN YOUNGBLOOD, each being first duly sworn, depose and say: That we are all and the only heirs at law of SILAS R. MOON, deceased, and that we hereby guarantee to save harmless the Canadian Bank of Commerce, at Portland, Oregon, by virtue of any future claims of heirs or creditors, that may arise against said Bank, or the estate of s aid decedent, as a result of said Bank surrendering to us, the undersigned, the contents of Safe Deposit Box No. 3218 held in said Bank in the name of the said SILAS R. MOON, now deceased. Subscribed end sworn to before me this 6th day of February, 9hl gt; Notary Public for Cregon. My Commission expires: Oct. 13 195 gt;0. w * * STATE OF WASHINGTON ) ) ) COUNTY OF KING ) as, , e, Charles . Larsen and Vivian Youngblood, each being first duly sworn, depose and say: That we are all and the only heirs at law of Silas Roy Moon, deceased, by virtue of his Last Will and Testament, ana that in pursuance of 3aid Last Will and Testament we have buried the said Silas Roy Moon, and in performance of this duty, and incidents thereto, we have paid from personal funds, the following accounts and amounts, in addition to the funeral expenses as listed in the account of Ginn's Funeral Home: Sept.23, 1 46 Trip by auto from auburn, Washington, 24 to Portland and Astoria, Ore.,and return To Auburn, Washington. 466 miles 10.34 pt .23 Meals and hotel 16.20 44 p'tarflb Paid for pressing of suit-(Suit left at fl ' Broadway, Dyers Cleaners, 1724 NE Union j . Avenue, on Sept.7,1 46 and delivered to Belmont Hotel) if f Se tu25 Telephone calls. j Sept.i pt.26 Recording Last will So Sestament with Multnomah county Clerk, Portland, Ore... Telephone ca.lls from Auburn, ashington to Astoria, Portland, Cannon Beach, State (Oregon) Income Tax, 1 46 1.31 1.50 .75 5.50 13.06 gt;48.66 Subscribed and sworn to before me this day 194?: Charles E. Larsen of Vivian Youngblood Auburn, Washington 1509 H. St., SB November 21, 1946 State of Oregon, Inheritance, Postal Building, 3rd Washington Sts., Portland, Oregon Gentlemen: There is enclosed, herewith, Report to tho State Treasurer of tho State of Oregon, of property Belonging to Estate of a Resident Decedent COVERING the case of Silas Roy Moon, killed in a legging accident September 19, 1946. The total value of decedent's estate is v100 hold in a safety deposit box in tho Canadian Bank of Commerce, Portland, Oregon, and this is to request that such release or waivers from inheritance tax bo issued and mailed to my address in self-addressed enclosed envelope. Yours very truly, Charles E. Larsen Report to the State Treasurer of the State of Oregon, of Property- Belonging to Estate of a Resident Decedent COPY IN THE MATTER OF THE ESTATE OF , Silas Roy Moon DECEASED STATE OF .0rS?.Son. Multnomah SS. County of ...... T Charles E. Larsen of the city of uburn . Washington . Executor of , and of the above-named ,P r.ff.?....f:.?. lt;y S*?.ftr; being first duly sworn, on oath depose: county of : , and state (Ex., Adm,, or Relative) 1. That the above-named decedent died testate on the .-,..u.1Jday of O.? ?.?.? .??.? ?.. ,46 A. D. 19. .., a resident of, and domiciled in, the state of Oregon, at the age of years, and left surviving as decedent's devisees or heirs at law: Name Relationship to decedent Age Amount of distributive share Ch-.rles . Larsen Vivian Youngblood Friend Friend 60 31 1/2 1/2 2. That the said decedent was a tenant or cotenant of a safe deposit box in Oregon located at The Canadlffi Biu f Oregon 3. That the personal property owned by the decedent at death wheresoever situated consisted of the following: Stocks and bonds, including those held in joint names of decedent and one or more persons Market Value M 0 H E Bank deposits and other personal property, including deposits, notes and other personal property not included in above schedule, held in Par Value Market Value the joint names of decedent and one or more persons Safety Deposit Box Ho. 3218 CASH 100,00 9100.00 c c ' 4. That the full and true value of the following described real property in the state of Oregon owned by the decedent at date of death was the sum of If 0 N E 5. That the following described real property in the state of Oregon and personal property wheresoever situated was transferred or conveyed (in trust or otherwise) by said decedent to the following persons prior to the death of decedent as a division or distribution of decedent's property or estate: B 0 B E 6. That the following described real property in the state of Oregon and personal property wheresoever situated was transferred or conveyed by said decedent to the following persons, which transfer or conveyance was not recorded or did not become effective in possession or enjoyment until at or after the death of decedent: B 0 B E 7. That there were in existence at the time of decedent's death the following trusts created by the decedent in his or her lifetime: 8. That said decedent was possessed of no other property, or any interest therein, including any interest in partnership property located in another state, except the following: B 0 B E 9. That the total value of said decedent's estate wheresoever situated is the sum of ...lv.U....Uw.. 10. I further state that the facts herein stated are true as I verily believe, and that this affidavit is given for the purpose of enabling the state treasurer of Oregon to determine the amount of inheritance tax, if any, due upon said estate, and to issue such releases or waivers from inheritance tax as may be necessary. Subscribed and sworn to before me thi 7s * . * gt; YUa c* . Charles E. Larsen Executor of the estate of Silas Roy Moon DECEASED f a.d. w.rrt jtkjL... day of tXL C - - c L j. gt;. S ii kJj t ...., Notary Public for state of My commission expires (Give full description of all property. Attach rider if insufficient space.) STATE PRINTING DEPT. ttrflkttit ,zmzbml Qxtnn t z ixztiitxxm Phone Broadway 0910 394 STARK STREET. PORTLAND. OREGON Bov. 9, 1925. To Whom It May Concern. I have known Silas Moon,an Indian young man, for over 25 years when he first came to Chemawa Indian School as a little boy ,and have been in touoh with him since leaving Chemawa,seeing him many times every year,and having been in close touoh with him. He is strictly honest,upright and industrious,and in all these years has never deviated from doing what is right. He can be placed in any position of trust. 5* X The deceased wage earner performed services in em loyment (as defined by the Social Security Act, as amended) for the following employers during the 1-year posted immediately preceding his death: : ,.ork Be an : ..ork leaded ADDRESS OF EMPLOYER: iionth :Year:Month -.Year DAME OF EMPLOYER Murphy Timber Co. ? ? Cape Creek Logging co. waldport, Oregon ? .estern Logging Co., ? ? ? 1945 uct. 1945 1*45 uov. 1*45 1945 Dec. 1945 Crown Zellerbaok Corp., Cathlamet, ..ashington Jan 1946 Jan. 1946 Barr-Helson Co. .ortland 4, Oregon 139 81 First Ave., Elk Creek Logging Co., Lstaoada, yregon cx S3 ?. 4 M. Operating co., llehalem, Oregon Deep River Timber Co., Deep River, lt;ash. Jan. 1946 Feb. 1*46 March 1946 April 1946 Apr. 1946 May 1946 June 1946 June 1946 Davis Logging Co., Cannon Leach, Oregon June 1946 Sept. 1946 t File this return with Collector of Internal Revenue on or before March 15, 1947. Any balance of tax due (item 9, below) must be paid in full with return. See separate instructions for filling out return. Plfll FORM 1640 Tr.lsury Department l.toi-Kal Revenue Service IC 0 r Y) U. S. INDIVIDUAL INCOME TAX RETURN FOR CALENDAR YEAR 1946 or fiscal year beginning , 1946, and ending 1946 ., 1947 EMPLOYEES. Instead of this form, you may use your Withholding Statement, Form W-2, as your return, If your total Income was less than 5,000, consisting wholly of wages shown on Withholding Statements or of such wages and not more than 100 of other wages, dividends, and Interest. Name .2u:a (PLEASE PRINT. If this return is for a husband and wife, use both first names) ADDRESS Was 230- 1.1. (PLEASE PRINT. 6th .ve. Street and number or rural route) Portland (City or town, postal zone number) Mul tnoa ah O r e go n. (County) (State) Occup '*a.a Logger sodai security no. 543-01-7824 Do not write In these spaces File Code Serial No. District (Cashier's Sump) (COPY) Your Exemptions List your own name. If married and your wife (or husband) had no Income, or if this Is a Joint return of husband and wife, list name of your wife (or husband). List names of other close relatives (as defined in Instruction 1) with 1946 Incomes of less than S500 who received more than one-half of their support from you. if this Is a Joint return of husband and wife, list dependent relatives of both. Your Income * Name (pisasa priol) R.;.i'j ii iiii HamttlpmateprmO MMUUUi Your I I I 1 I II S I Enter your total wages, salaries, bonuses, commissions, and other compensa- Insurance, bonds, etc. Members ot armed forces and persons claiming traveling tion received In 1946, BEFORE PAY-ROLL DEDUCTIONS for taxes, dues, or reimbursed expenses, see Instruction 2. Print Employer's Nams (see attacnea li sTT When Employed (City and Slate) Amount 1282. .9.7. Enter total here 3. Enter here the total amount of your dividends 4. Enter here the total amount of your interest (including interest from Government obligations unless wholly exempt from taxation) 5. If you received any other income, give details on page 2 and enter the total here 6. Add amounts in items 2, 3, 4, and 5, and enter the total here 1283 97 1283 97 How to Figure Your Tax. IF YOUR INCOME WAS LESS THAN 5,000. You may find your tax In the tax table on page 4. This table, which Is provided by law, automatically allows about 10 percent of your total Income for charitable contributions, Interest, taxes, casualty losses, medical expenses, and miscellaneous expenses. If your expenditures and losses of thesrclasses amount to more than 10 percent. It will usually tat to your advantage to Itemize them and compute your tax en page 3. IF YOUR INCOME WAS 5,000 OR MORE. Disregard the tax table and compute your tax on page 3. You may either take a standard deduction ol S500 or Itemize your deductions, whichever Is to your advantage. HUSBAND AND WIFF.-lf hushand and wife file separate return*, ?nrj Cn Itemizes deductions, the other must also itemize deductions. r 7. Enter your tax from table on page 4, or from line 12, page 3 OO 165 8. How much have you paid on your 1946 income tax? (A) By withholding from your wages 165 90 Tax Due (B) By payments on 1946 Declaration of Estimated Tax -- 90 or Refund 9. If your tax (item 7) is larger than payments (item 8), enter BALANCE OF TAX DUE here If) If vnnr navmenrsfirem SOare larp-er than vnur tax (item 7 enter the OVERPAYMENT here s - - s 40 90 Check (i/) whether you want this overpayment: Refunded to you D; or Credited on yc ur 1947 estimated tax If you filed a return for a prior year, what was the latest vear? *T.** *.... I Is your wife (or husband) making a separate return for 1946? ...fie LpQBtland Dr6 oiIf Ycs, writeWow: rYu ' No To which Collector's office was it sent? ...r7*T*tr*''7twT*1*(* STfT ft Name of wife (or husband) .. .. ... Collector's office to which sent To which Collector's office did you pay amount claimed in item 8 (B), above? I declare under the penalties of perjury that this return (including any accompanying schedules and statements) has been examined by me and to the best of my knowledge and belief is a true, correct, and complete return. (Signature of taxpayer) (Date) Mar,.12, 1947 (Signature of perseniojl ihanjaxpa er or .agent; t preparing return) . (Date' Executor * (Name of firm or employer, if any) (If this is a joint return of husband and wife, it must be signed by both) over 10 19264-1 - SILAS ROY MOOH 1946 5 gt; Pr gt;fnt iimnlMifia TJnm ..hana Hmnl nvArl PUv l ..jy - -- *- - - W rfw- Vl . uuu uvuue auiw uu w f Crown ellerback, Corp. Cathlaiaet, Washington Barr-Helson Co., Portland 4, Oregon 129 s.W. First Ave *4.7 82.58 Elk Creek logging Co., V. M. Operating Co. John S. Brandls, logger Deep River Timber Co., Davis Logging Co., , staoada, Oregon BOX 32 53.35 Hehalem, Oregon 90.00 Corvallis, Oregon 545 H. 24th St. 26.81 Deep River, Washington 76.76 Cannon Beach, urt 719.75 HOTS: Silas Roy Moon was killed in logging aooidenton September 19, 1946. His Last Kill and Testament recorded in Multnomah county Clerk's office, .Sept. 6,1946. His heirs named; Charles . Larsen and daughter, Vivian Youngblood. He had no family or known relatives. Estate less than v500 consequently no probate proceedings. Claim filed as person paying funeral expenses and equitably entitled to refund* Charles K. Larsen Exeouter Vv-W lt; D. not itemize deductions li (1) You determine your tax from the tax table on page 4, or (2) Your total Income le S5.000 or more and you claim the S500 standard deduction. It husband and wife llylnt together at end of year file separate returns and one Itemizes deductions, the other must Hie his or her return on Form 1040, and must also itemize deductions. Page 3 I DEDUCTIONS Describe deductions and state to whom paid. If more space is needed, list deductions on separate sheet of paper and attach to this return. Amount S. Contributions ' Allowable Contributions (not in excess of 15 percent of item 6, page 1) v. . Interest Taxes s Losses from fire, storm, shipwreck, or other casualty, or theft. Total Allowable Losses (not compensated by insurance or otherwise) '. s .... Medical and dental efpenses s Miscellaneous (See Instructions) TOTAL DEDUCTIONS , TAX COMPUTATION FOR PERSONS NOT USING TAX TABLE ON PAGE 4 1. Enteranrcraat shown in item 6, page 1. This is your Adjusted Gro'ss Income 2. Enter DEDUCTIONS (if deductions are itemized above, enter the total of such deductions; if adjusted gross income (line 1, above) is 5,000 or more and deductions are not itemized, enter the standard deduction of 500) '. 3. Subtract line 2 from line 1. Enter the difference here. This is vour Net Income 4. Enter your exemptions ( 500 for each person whose name is listed in item 1, page 1) 5. Subtract line 4 from line 3. Enter the difference here - - 6. Use the tax rates in instruction sheet to figure your combined tentative normal tax and surtax on amount entered on line 5. Enter the tentative tax here. (If line 3 above includes partially tax-exempt interest, see Tax Computation Instructions) 7. Enter here 5 percent of amount entered on line 6 - 8. Subtract line 7 from line 6. Enter the difference here. This is your combined normal tax and surtax. (If alternative tax computation is made on separate Schedule D, enter here tax from line 12 of Schedule D) IF YOU USED THE 5506 STANDARD DEDUCTION IN LINE 2, DISREGARD LINES L 10, AND 11, AND COPY ON LINE 12 THE SAME FIGURE YOU ENTERED ON LINE I 9. Enter here any income tax payments to a foreign country or U. S. possession (attach Form 1116; j S. 10. Enter here any income tax paid at source on tax-iree covenant bond interest 11. Add the figures on lines 9 and 10 and enter the total here 12. Subtract line 11 from line 8. Enter the difference here and in item 7, page 1. This is your tax . If you use this table, tear off this page and file only pages 1 and 2 Page 4 TAX TABLE FOR PERSONS WITH INCOMES UNDER 5,000 NOT COMPUTING TAX ON PAGE 3 Read down the shaded columns below until you find the line covering the total Income you entered In Item 6, page 1. Then read across to the column headed by the number corresponding to the number of persons listed In Item 1, page 1. Enter the tax you find there hi item 7, page 1. : If total Income in Item 6, page i, is r I At least But less than 0 550 1 573 550 575 600 t 600 P 625 j 650 1 675 625 650 675 700 700 i 725 S 750 IV- .775 725 750 775 800 7 800 : 825 850 ': 875 825 850 875 900 900 t 925 950 t 975 925 950 975 1,000 1,000 1,025 ' 1,050 ; 1,075 1,025 1,050 1,075 1,100 1,100 1,125 1,150 1,175 1,125 1,150 1,176 1,200 1,200 t,225 * 1,250 j 1,275 1,225 1,250 '1,275 1,300 1,300 1,325 1,350 1,375 1,325 1,350 1,875 1,400 1,400 S 1,425 -1,450 ;i,47 .,. 1,425 1,450 1,475 1,500 1,500 1,525 , 1,550 1,575;. 1,525 1,550 ,-..1,575' 1,600 1,600 1,625. 1,650 ?1,675 i;625 i 1,650 1,375 1,700 11,700 1,725 1,750 1,775 1,725 1,750 1*776 1,800 1,800 1,825 1,850 1,875 1,825 1,850 1,875 1,900 1,900 1,925 1,950 1,975 1,925 1,950 1,975 2,000 2,000 2,025 2,050 2,075 2,025 2,050 2,075 2,100 2,100 2,125 2,150 2,175 2,125 2,150 2,175 2,200 2,200 2,225 And tho number of persons llstod in item 1, page 1, Is 4 or more Your tax Is- 0 1 5 10 14 18 23 27 31 35 40 44 48 52 57 61 65 70 74 78 82 87 91 95 100 104 108 112 117 121 125 129 134 138 142 147 151 155 159 164 168 172 176 181 185 189 194 198 202 206 211 215 219 223 228 232 236 241 245 249 253 258 262 266 271 275 279 283 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 9 0 0 13 0 0 17 0 0 22 0 0 26 0 0 30 0 0 34 0 0 39 0 0 43 0 0 47 0 0 52 0 0 56 0 0 60 0 0 64 0 0 69 0 0 73 0 0 77 0 0 81 0 0 86 0 0 90 0 0 94 0 0 99 4 0 103 8 0 107 12 0 111 16 0 116 21 0 120 25 0 124 29 0 128 33 0 133 38 0 137 42 0 141 46 0 146 51 0 150 55 0 154 59 0 158 63 0 163 68 0 167 72 0 171 76 0 176 81 0 180 85 0 184 89 0 188 93 0 If total Income In Item 6, page 1, Is At least But less than 2,225 2,250 2,275 82,250 2,275 2,300 2,300 2,325 2,350 2,375 2,325 2,350 2,375 2,400 2,400 2,425 2,450 2,475 2,425 2,450 2,475 2,500 2,500 2,525 2,550 2,575 2,525 2,550 2,575 2,600 2,600 2,625 2,650 2,675 2,625 2,650 2,675 2,700 2,700 2,725 2,750 2,775 2,725 2,750 2,775 2,800 2,800 2,825 2,850 '2,875 2,825 2,850 2,875 2,900 2,900 2,925,, 2,950 2,975 2,925 2,950 2,975 3,000 3,000 3,050 3,100 3,150 3,050 3,100 3,150 3,200 3,200 3,250 3,300 8,350 3,250 3,300 3,350 3,400 3,400 3,450 3,500 3,550 3,450 3,500 3,550 3,600 3,600 3,650 3,700 3,750 3,650 3,700 3,750 3,800 3,800 3,850 3,900 3,950 3,850 3,900 3,950 4,000 4,000 4,050 4,100 4,150 4,050 4,100 4,150 4,200 4,200 4,250 4,300 4,350 4,250 4,300 4,350 4,400 4,400 4,450 4,500 4,550 4,450 4,500 4,550 4,600 4,600 4,650 4,700 4,750 4,650 4,700 4,750 4,800 4,800 4,850 4,900 4,950 4,850 4,900 4,950 5,000 And the number cf persons listed In Item 1, page 1, is 1 2 3 4 5 6 7 8 9 or more Your tax Is 288 193 98 3 0 0 0 0 292 197 102 7 0 0 0 0 296 201 106 11 0 0 0 0 300 205 110 15 0 0 0 0 305 210 115 20 0 0 0 0 309 214 119 24 0 0 0 0 313 218 123 28 0 0 0 0 318 223 128 33 0 0 0 0 322 227 132 37 0 0 0 0 326 231 136 41 0 0 0 0 330 235 140 45 0 0 0 0 335 240 145 50 0 0 0 0 339 244 149 54 0 0 0 0 343 248 153 58 0 0 0 0 347 252 157 62 0 0 0 0 352 257 162 67 0 0 0 0 356 261 166 71 0 0 0 0 360 265 170 75 0 0 0 0 365 270 175 80 0 0 0 0 369 274 179 84 0 0 0 0 373 278 183 88 0 0 0 0 377 282 187 92 0 0 0 0 382 287 192 97 2 0 0 0 387 291 196 101 6 0 0 0 391 295 200 105 10 0 0 0 396 299 204 109 14 0 0 0 401 304 209 114. 19 0 0 0 405 308 213 118 23 0 0 0 410 312 217 122 27 0 0 0 415 317 222 127 32 0 0 0 419 321 226 131 36 0 0 0 427 327 232 137 42 0 0 0 436 336 241 146 51 0 0 0 445 344 249 154 59 0 0 0 455 353 258 163 68 0 0 0 464 361 266 171 76 0 0 0 474 370 275 180 85 0 0 0 483 379 284 189 94 0 0 0 492 388 292 197 102 7 0 0 502 397 301 206 111 16 0 0 511 407 309 214 119 24 0 0 521 416 318 223 128 33 0 0 530 425 326 231 136 41 0 0 539 435 335 240 145 50 0 0 549 444 343 248 153 58 0 0 558 454 352 257 162 67 0 0 568 463 361 266 171 76 0 0 577 472 369 274 179 84 0 0 586 482 378 283 188 93 0 0 596 491 387 291 196 101 6 0 605 501 396 300 205 110 15 0 615 510 406 308 213 118 23 0 624 520 415 317 222 127 32 0 633 529 424 325 230 135 40 0 643 538 434 334 239 144 49 0 652 548 443 342 247 152 57 0 662 557 453 351 256 161 66 0 671 567 462 360 265 170 75 0 680 576 471 368 273 178 83 0 690 585 481 377 282 187 92 0 699 595 490 386 290 195 100 5 709 604 500 395 299 204 109 14 718 614 509 405 307 212 117 22 727 623 518 414 316 221 126 31 737 632 528 423 324 229 134 39 746 642 537 433 333 238 143 48 756 651 547 442 342 247 152 57 765 661 556 452 350 255 160 65 774 670 565 461 359 264 169 74 784 679 575 470 367 272 177 82 793 689 584 480 376 281 ' 186 91 it U. I. GOVERNMENT PRINTING OFFICE 16 49254-1 UNITED STATES DEPARTMENT OF THE INTERIOR OFFICE OF INDIAN AFFAIRS FIELD SERVICE Klamath Indian Agency, Klamath Agency, Oregon, February 9th, 1935. To Whom It May Concern:- Mr* Silas Moon, the hearer, worked under my direction as fire guard on the Klamath Indian Reservation during part of the summer season 1934. I found Mr. Moon to he a man of sober hah its, conscientious, loyal and a hard worker. I would not hesitate to recommend him for any fire job for which he may qualify. U 44 . 4v-i* gt; Silas 0. Davis, Forest Banger in charge of Fire Protection. 5-1142 UNITED STATES DEPARTMENT OF THE INTERIOR INDIAN FIELD SERVICE WARM SPRINGS INDIAN AGENCY, Warm Springs, Oregon. Tune *t, 1931)-. To whom it may concern: The bearer, Silas Moon, has worked here on Emergency Conservation Work for the past six months. During that time he has been in charge of crews on logging, dbroad construction. Kis work has been very satisfactory, and I can recommend him to anyone who needs his services. Patrick Gray, Forest Superviaor. W. d. WALSH BYRON WOLFE STEWART, WALSH WOLFE 25 Years Experience in Western Timber TIMBER ESTIMATING - LOGGING ENGINEERING LOGGING APPRAISALS - PROPERTY MANAGEMENT IOOI-2 BEDELL BLDG. I Portland, Oregon June 7th, 1927. To Whom It May Concern: The undersigned has known Mr. S. R, Moon for a number of years, he having worked for and under me for considerable time. I can cheerfully recommend Mr. Moon as being a man of good habits and industrious and so far as I know entirely honest. I think he is well worth giving a chance to in any kind of work that he can do. Yours very truly, B D. E. Stewart. F. J. MARTIN t A. R. MARTIN Portland Tinware Manufacturing MANUFACTURERS AND REPAIRERS TIN, COPPER, GALVANIZED IRON WARE PHONE BROADWAY 3444 S 47 FIRST STREET ' * PORTLAND, OREGON. :tv V- frvipf yW r d ncyyrt lt;L /yv Ttn stm . lt; 7 jZarC quot;P H l/c sWW : z?24d7* 'Z2*t l. / n . a L . -7f /6?/*. Ml Elam: Mr. Juffy, the Government Scaler at Pelican Bay Lumber Company, wants you to report there for work, Monday morning. He would like to have you keep this quite, as they are not entirely sure that they can employ you, as the N.L.R.B. requires that former employees be given preference. -ID I hate to lose either of you, but if you can better yourselves, you'll be getting just what I would like to do for you. When work is over up there, you maybe sure tha you can have your old jobs back here. C.L.P. UNITED STATES DEPARTMENT OF THE INTERIOR OFFICE OF INDIAN AFFAIRS FIELD SERVICE To Whom This May Come GREETINGS: This is to certify that I, Charles E. Larsen, Senior Clerk, temporarily in charge of the Chemawa Indian School, have official custody of the records of the Chemawa Indian School, and that the records show that Silas Moon originally entered the Chemawa Indian School on April 15, 1895, and that he was enrolled from Alaska and that his age is given as 12 years. The records do not give the exact date of his birth. Using the above figures the year of his birth would be 1883, and his age at the present time 58 years. VWojcA ft gt; k * jo'*--jl gt; lt; / Charles E. Larsen Sr. Clk. in Charge Chemawa Indian School Chemawa, Oregon June 23, 1941 DEPARTMENT OF COMMERCE BUREAU OF THE CENSUS a uwitfTYTY tt WASHINGTON APPENDIX U. EVIDENCE FOR PROVING FACTS OF BIRTH Types of evidence generally accepted for establishing the facts of birth when no certificate was registered at the time of birth are shown by the following list. This list also indicates their order of preference. Records less than 5 years old will not be considered as evidence but should be taken into consideration by the State registrar in his investigation of the case. 1. Baptismal, cradle roll, or other church record (If the applicant does not have such a record, he should be instructed to write the present pastor of the church where his baptism took place.) 2. Family Bible record (Bible records will be considered as class B evidence unless proved beyond doubt to have been made before the fourth birthday of the registrant.) 3. Physician or hospital record (An exact copy (preferably photostat) of the office record of the physician who attended the birth, or a copy of the hospital record of the birth.) 4. Birth certificate of the registrant's child (To have complete weight, this birth certificate should have been filed not less than 5 years before the time of the application for delayed registration.) 5. Record from a local, State, or Federal census (The applicant may obtain application forms for this record from his county health officer, the State Bureau of Vital Statistics, or the Bureau of the Census at Washington, D.C.) 6. School record (The applicant should write to the superintendent of schools requesting a record of age or birth date, birthplace, and parents' names as given on entrance in school.) 7. Insurance policy (If the applicant no longer has the policy, he should write to the insurance company for a statement showing the birth date, birthplace, and names of parents as shown on the application for the policy.) 8. Other acceptable records (Records of military service, or employment; marriage or other license; voting registration record; natualization papers, immigration record, or passport; record of hopitalization.) 9. Affidavit (If affidavit is to prove birth date, person taking oath must state acceptable reasons why he knows and remembers the date. Affidavits need not be 5 years old, but credit will not be given for more than one affidavit as proof of any one item.) 12232 Warm Springs, Oregon Deoember 8, 1941 Mr* Frank A, Boyle, Registrar of Vital Statistics. Auditor of Alaska Juneau, Alaska Dear Mr. Boyle: Please find enclosed herewith, a money order in the amount of 1.50, the fee for the Issuing of a birth certificate which 1 am requesting be sent to me at the above address. Mr. James I*9 Hobgood, Prin. Juneau-Douglas Schools has advised that X can secure this birth certificate from you, as he has completed the necessary papers in regard to myself for securing the certificate. Trusting no futher information is needed and I thank ng you, I remain Yours very truly, Silas Moon SM/J ends Russell, Hoppe Wakefield, Inc. Investment Securities wilcox building Portland, Oregon y// /j gt;s W y / k SEATTLE. WASH. ABERDEEN. WASH. PORTLAND, ORE Western mira i lt; (Northwest Logging Operators Association) 32A Pi he Street TELEPHONE ATWATER 4873 PORTLAND. OREGON GEO. B. SYPHER GtN'L MOR. AND S C Y / 6 (ATJLs r J C 4U TUy 3, / f * * obi l c L , x--e i x A, XAjt' tv Durable Douglas Fir //fY U 4-XASL CA - --*t Coast Hemlock Sitka Spruce Red Cedar I UNITED STATES DEPARTMENT OF THE INTERIOR 339.4c OFFICE OF INDIAN AFFAIRS FIELD SERVICE Klamath Indian Agency Klamath Agency Oregon April 6, 1940 TO WHOM IT MAY CONCERN: The bearer of this letter, Mr. Silas Moon, Indian, is desirous of obtaining employment as brush piler with any of the lumber companies operating on the Klamath Reservation. Mr. Moon is an experienced brush piler. Any consideration given to Mr. Moon for employment as a brush piler will be appreciated by this office. B. G. Courtright, S. D. A. B. G. Courtnght Superintendent by J. S. Monks, Dep. DistO Agt Astoria, dregdn, December g is4.y Mr. -Charles a. Larsen 1509 H St. S. .. Auburn, Washington IN ACCOUNT WITH Funerals of Character Qwmi fyi4M /ial Jlome i Telephone J p. 5 531 FRANKLIN AVENUE a/c services rendered Silas Roy Moon, decetsed, Sept. 19/2S, 1 Prolessional services and ctsket es selected . . . . ) oneys advanced by us for other fees: Cemetery charges . Clergy fee . . Or aalst .... Telephone calls Z certified copies of death 82.00 5.00 2.50 2.67 1.00 :j.00 Total - .17 88.17 rAID Is FULL 12/9/46 Ginn's Funeral some by Form W-2. , COPT V. S. Treasury Department Internal lierenue Service WITHHOLDING STATEMENT 1947 Wages Paid and Income Tax Withheld EMPLOYEE'S COPY (DUPLICATE) Total wages (before pay-roll deductions) paid in 1947 .. 2 .72 Federal income tax withheld, if any EMPLOYEE TO WHOM PAID (Print name, full address, and Soc. Sec. Noi) SILAS MOON 5I4.3 01 7821+ 230 6 Ave. No.W. Portland, Oregon (To EMPLOYEE: Change name and adda-ssl ddrfSsVn noa cor EMPLOYER BY WHOM PAID (NamerStldress. and S. S. identification No.) CROWN ZELLERBACH CORPORATION CATHLAMKT. WASHINGTON 04-O41325O APP. B.I.R. 10 23.46 To EMPLOYEE: This is your copy. Do not file with Collector. If yon use Employee's Optional Income Tax Return on back of the original Form W-2 as your return, you should make a record of your return below: Write total of wages shown on this and all your other 1947 Withholding Statements .. Write total of all other wages divldends, and interest . Write total here . *.. f. Add line, 1 and (fi P i l* *M, rHrf 5 Include fj)V i*eHof botl iT noa correctly shown) both husband and wife, show husband's income ; wife's income dependents claimed: (Name) (Relationship) (Name) (Relationship) (Name) (Relationship) (Name) (Relationship) Astoria, Oregon ...J. N? 3412 GINN'S FUNERAL HOME i 531 Franklin Ave. Received of i C Ufig The Sum of . Z 3i Form W-2 U. 8. Treasury Denertmen. lDterot.1 Revenue Service WITHHOLDING STATEMENT 1946 Wages Paid and Income Tax Withheld EMPLOYEE'S COPY (DUPLICATE) EMPLOYEE TO WHOM PAID (Print nam., addrns, and Social Security No.) Silas R. Moon 542-01-7624 220 H. W. 6th Portland, Oregon (To EMPLOYEE: Change name and address if not correctly shown) Total wages (before pay-roll deductions) paid in 1946 . 2..S.8. Federal income tax withheld, if any .60.. fER BY WHOM PAID (Nam., address, and S. S. id.ntil SCO. 139 S. W. FIRST AVE. PORTLAND 4. OREGCH 93-0119 406ir rn on back of ake a record To EMPLOYEE: This is your copy. Do not file with Collector If you use Employee's Optional Income the original Form W-2 as your return i of your return below: 1. Write total of wages shown your other 1946 Withhold: 2. Write total of all ol and interest QV N 3. Add Unes4 lt;ttjA2. JJ Write total here 4c. Ifjii ificliMb gt;rncome of both husband and wife, show hus- d's jfcome ; wife's income of aSpendents claimed: (Relationship) (Relationship) (Relationship) (Relationship) rorm W-2 ' U. 8. Treasury Department liiterukl Revenue Service WITHHOLDING STATEMENT 1946 Wage* Paid and Income Tax Withheld EMPLOYEE'S COPY (DUPLICATE) EMPLOYEE TO WHOM PAID (Print nam., address, and Social Security No.) 543-01-7824 Silas Roy Moon 230 H. W. Sixth ATO. Portland 0, Oregon (To EMPLOYEE: Change name and address if not correctly shown) Total wages (before pay-roll deductions) paid in 1946 .. 53 .35. Federal income tax withheld, if any * 31.90 EMPLOYER BY WHOM PAID (Name, address, and S. S. id.ntif Elk Creek Logging Co. Box 33 Estacada, Oregon 93-01 16 44829-3 rn on back of ake a record To EMPLOYEE: This is your copy. Do not file with Collector If you use Employee's Optional Income the original Form W-2 as your return, yi' of your return below: /f 1. Write total of wages shown orf-tnia Vi your other 1946 WithholdiHa StcKte ents 2. Write total of all otfre wagSS THvidends, and i n t Ai-ont O r 3. Add line fiu . ) Write total here 4c. IMii iflFluaW gt;rncome of both husband and wife, show hus- id's jfe me ; wife's income of dependents claimed: HName) (Relationship) (Nam.) (Relationship) (Nam.) (Relationship) (Nam.) (Relationship) Form W-2 U. 8. Tre tmrj Department Internal Revenue Service WITHHOLDING STATEMENT 1946 Wages Paid and Income Tax Withheld EMPLOYEE'S COPY (DUPLICATE) EMPLOYEE TO WHOM PAID (Print nam., address, and Social Security No.) 543-01-7824 Silaa Boj Moon 230. H.W. Sixth Are. Portland, Oregorj (To EMPLOYEE: Change name and address if not correctly shown) Total wages (before pay-roll deductions) paid in 1946 -90,00 ..ia ao Federal income tax withheld, if any EMPLOYER BY WHOM PAID (Nam., address, and S. S. identii 93-03360. YAM Operating Hehalea, Oregon m on back of ake a record To EMPLOYEE: This is your copy. Do not file with Collector If you use Employee's Optional Income the original Form W-2 as your return i' of your return below: 1. Write total of wages shown o, your other 1946 WithholdiHa StcK rj nta 2. Write total of all offre wagescsSividends, and interest Q 3. Add line gt;4 lt;W 2. lt; Write total here 4c. IfJit sN lucW-rncome of both husband and wife, show hus- td's tfcbme ; wife's income of dependents claimed: faam.j (Relationship) (Nam.) (Relationship) (Nam.) (Relationship) (Nam.) (Relationship) Form-W-2a lt; U. S. Treasury Department Internal Revenue .Service WITHHOLDING STATEMENT 1946 Wages Paid and Income Tax Withheld COLLECTOR'S COPY (TRIPLICATE) EMPLOYEE TO WHOM PAID (Print name, address, and Social Security No.) 543-01-7824 Silas Bay Moon 230* I.w. Sixth Are. Portland, Oragot) Total wages (before pay-roll deductions) paid in 1946 . 90.00 Federal income tax withheld, if any 13.90 EMPLOYER BY WHOM PAID (Name, address, and S. S. identification No.) 93-0336061 YAM Operating Co. flahaless, Oregon To EMPLOYER: 1. Prepare this form in triplicate for each employee (a) from whom tax has been withheld or (b) whose wages for any pay-roll period exceeded the amount of one withholding exemption (even though ' no tax was withheld). 2. Fill in: (a) the employee's name, address, and Social Security number; (b) the total wages paid before any pay-roll deductions; (c) the amount of tax withheld, if any; and (d) your name, address, and S. S. identification number. 3. Give original and Employee's Copy to the employee. 4. Forward this triplicate copy and all other triplicate copies, together with your yearly Reconciliation Statement, Form W-3, to your Collector of Internal Revenue with your Withholding Tax Return (Form W-l) for the fourth quarter of the calendar year (or with your final return). OPO 18 44829-3 Form W-2 0. S. Treasury DeV rtment Internal Revenue Service WITHHOLDING STATEMENT 1946 Wages Paid and Income Tax Withheld EMPLOYEE'S COPY (DUPLICATE) EMPLOYEE TO WHOM PAID (Print nam., addr.ss, and Social Security No.) P. R. Moon ? (To EMPLOYEE: Change name and address if not correctly shown) Total wages (before pay-roll deductions) paid in 1946 gt; Federal income tax any EMPLOYER BY WHOMfM gt; John S. Bran T , Log e 646 Re, 34th Street, Corrallis, Oregon ss. and S. S. identification No.) 16 44S2 -2 To EMPLOYEE: This is your copy. Do not file with Collector. If you use Employee's Optional Income Tax Return on back of the original Form W-2 as youf- efffin, you should make a record of your return below: i- yvJ/ 1. Write total of uaae r vlri bn trjj gt; and all your othey'M olWitHHoWing Statements total eA lUorfief wages, dividends, teresfcrrfL. idfciJnes 1 and 2. Write total here If line 3 includes income of both husband and wife, show husband's income ; wife's income - List of dependents claimed: (Name) (Nam.) (Nam.) (Name) (Relationship) (Relationship) (Relationship) (Relationship) Form-W-2 U. S. Treasury Department Internal Revenue Service WITHHOLDING STATEMENT 1946 Wages Paid and Income Tax Withheld EMPLOYEE'S COPY (DUPLICATE) EMPLOYEE TO WHOM PAID (Print name, address, and Social Security No.) SilaB Roy Moon 543-01-7824 P30- 3.W. 6th *ve. Portland. Ore. (To EMPLOYEE: Change name and address if not correctly shown) Total wages (before pay-roll deductions) paid in 1946 Federal income tax wjthj any EMPLOYER BY WHOM ss. and S. S- identification.No.) DEEP RIVER TIMBER COMPANY DEEP RIVER, WASHINGTON SS 91-0196932 To EMPLOYEE: This is your copy. Do not file with Collector. If you use Employee's Optional Income Tax Return on back of the original Form W-2 as youj;-tefwrn, you should make a record of your return below: CT?:S)'V'( 1. Write total of ia sfsr VsTbn tHiV and all your othe 9 ro WitHrio ing Statements .. . total cjKall 3m T wages, dividends, teresfcrr . 8 dr ftes 1 and 2. Write total here If line 3 includes income of both husband and wife, show husband's income ; wife's income List of dependents claimed: (Name) (Relationship) (Name) (Relationship) (Na.ne) (Relationship) (Name) (Relationship) Form W-2 U. 8. Treasury Department Internal Revenue Service WITHHOLDING STATEMENT 1946 Wages Paid and Income Tax Withheld EMPLOYEE'S COPY (DUPLICATE) EMPLOYEE TO WHOM PAID (Print nam., address, and Social Security No.) Silas Soy Moon, 30 H. 1* 6th., AYO., Portland, Ore. 543-01-7824 (To EMPLOYEE: Change name and address if not correctly shown) Total wages (before pay-roll deductions) paid in 1946 iwui.fi. Federal income tax withheld, if any 9Q.*m. EMPLOYER BY WHOM PAID (Nam., address, and S. S. identiH DAVIS I OGGING CO. CANNON BtACH, ORE. IS 82 -3 93-0331348 rn on back of ake a record To EMPLOYEE: This is your copy. Do not file with Collecto: If you use Employee's Optional Income the original Form W-2 as your returnj yi of your return below: 1. Write total of wages shown o; your other 1946 Withholding St fes nts 2. Write total of all otmV wages jlividends, and interest Q gt;i y 8 3. Add lirjes 'S 2. Writ, total her. 4c. IfJiif? staficlua -rncome of both husband and wife, show hus- id'sv tfcome ; wife's income. of tt pendents claimed: tolaaM) (Relationship) (Nam.) (Relationship) (Nam.) (Relationship) (Nam.) (Relationship) as o fa Q u r gt; u CO U lt;?2 e . fig*. QBU aifa s o * s 5 Bi glJ all Si Bjj M Ptf 2 ' lt;3 g g 0 3,1 S s** Q c . zsftr gjgSStr *3ft Sgfa-a z*o 9 rf * lt; Oregon State Board of Health Division of Vital Statistics Standard-Certificate of Death state Filg No Local Registrar's No. STATE OF OREGON 1. PLACE OF DEATH: (a) County .. Loxer Mahal District, rural Qlatsop (b) City or town (If outside city or town limits write RURAL) fc) Name of hospital or institution: (If not In hospital or institution write street number or location) (d) Length of stay: In hospital or institution. - (Specify whether In this community * J ?*? . In state .. W JP1558 venrs, months or days) 3. (a) FULL NAME alias it97 ,*99 . 2. USUAL RESIDENCE OF DECEASED: (a) State -..0?8 Q k.;. (b) County . (c) City or town QifflEffln.. BfJlCh.. Clatsop lt;d gt; Street No. (If outside city or town limits write RURAL) (If rural Rive location) fe) If foreign born, how ions in U. S. A.? . A. 3. (b) If veteran, name war .. 3. (c) Social Security Sk3 gt;ai-n No. Male sAlte Indian 4. Sex -JBBBSSC- 6. (b) Name of husband or wife 6. (a) Single, widowed, married d rc Divorced 20. Date of death: year . MEDICAL CERTIFICATION Month M0Pt day . hour JSL minute jQ B.*M S. (c) Age of husband or wife . years ereby certify that I attended the deceased from 7. Birth date f deceased if alive Sept. 18, 1883 (Year) 8. Age: Years 61. Juneau. Al sra. Days If less than one day 9. Birthplace .. (City, town, or county) (State or foreign country) 10. Usual occupation H.9lld....LQB*ydfi(r. 11. Industry or business Name LQSging. Ii'2- a 113. If IVs- No-.record Birthplace . Maiden name . Birthplace (Citj(- town, or county) - m rm A (State or foreign country) (State or foreign country) (City, town, or county) 16. (a) Informant's own signature ..VV*** P. jf*.-jjj*.j j**.. lt; Addr. Aj urnx j MMagton 17. (a) Burial (b) Date thereof Sept. 25 ,- U lt; ' (Moitth) i Day) fYear) (Burtsl, cremation, or removal) (c) Place: burial or cremation gt;to9QjWQ j A8 /W A Ruth E. Ginn 18. (a) Signature of funeral director *. *T?.... -SZTTOz* 531 Franklin Ave. Astoria. Pro 21. I hereby certify tha 12 30 after 1 ; that I last saw h alive and that death occurred on the date and hour stated above. Immediate cause of death , Duration crushed chest and abdomen (Include pregnancy within 3 months of death) Major findings: the cause death should be statistically 22. If death was due to external causes, fill In the following: Accident (a). Accident, suicide, or homicide (specify) 1 V Date of occurrence Els gt;. .rUml, ClatSOp . C.Q.. lt;c) Where did injury occur? Sfipt. 19J 19ltQ (City or town) (County) (State) (d) Did injury occur in or about home, on farm, in industrial place. lt;b) Addres Septs J0JU6 ,b gt; .Q LJ tlw... 19. ia) (Date received local registrar (Registrar's aignaturei in public place? Whil 23. Slgnsture Address yoO (Specify type of place) T a, TL nfiniamZIfThoi sb* Astoria, Qregi (M. D. or oU Date signed Z Z, CERTIFICATE OF COPY STATE OF OREGON COUNTY OF CLATSOP, CITY OF SEASIDE, ss. I, GAULT PATTON, AUDITOR AND POLICE JUDGE of the City of Seaside, do hereby certify that I have compared the foregoing copy of the certificate of death of Silas Hoy Moon with the original thereof, and that the same is a full, true and correct transcript of such original certificate of death and of the whole thereof as the same appears on file and of record in my office, and in my care and custody. IN WITNESS WHEREOF, I have hereunto set my hand and the seal of the City of Seaside affixed this.....39. day opg. Sepl ber./ .... 19.1*6.. Auditor and Police Judge of the City of Seaside, (seal) IT: MP: men 7102199-47 Tacoma, Washington 1839 East Franklin Taooma, Washington St Mr. Clark Squire. Collector Intelusx nevenue service, laoeoa *, naaningten umur oir: in re: mr.oxiau Key keen, deo, In response . gt;uux- letter ei the 16 th, instant, I sua enole*ine, nerewith, rwruia w-is received irea tne iexxewing empxeyera skewing tne tetaX amount, ef wages received ana tne tetal ajaeuut el iuueiae taut wuiok wae wltsveeld urev.n z-exxerfceo*. cerp. i ari-*.eXos gt;n Us. s-Xiv Creea. ise6feine Co. V. * m. Operating Co. Jean o. Jbrauals, b6 r Deep liiver Timfcer Ce., Davis i*egging c .t audress watuxamet, ..asuin ten .ur.xtuia, Oregon asbaoada, Oregon Heij.al.ett, Cregea o rv axxi a.Oregon Deep River, ..aekingten Cannon ieaok, Ovsgsa There ia aXeo enuloaed certified oopj ef death. Very truly yours, Charles i.. i gt;areen TREASURY DEPARTMENT internal revenue service Tacoma 2, Wash. OFFICE OF THE COLLECTOR district of Washington April 15 , 1947 IN REPLYING REFER TO IT:MP:meh 7102199-47 Mr. Charles E. Larsen, Executor Estate of Mr. Silas Roy Moon 1509 H. Street, S.E. Auburn, Washington In re: Mr. Silas Roy Moon, Deceased Dear Mr. Larsen: Reference is made to the above-named taxpayer's 1946 income tax return. You are requested to furnish us with copies of Forms W-2 received from the following employers showing the total amount of wages received and the total amount of income tax which was withheld. Name Address Crown Zellerback Corp. Cathlamet, Washington jVBarr-Nelson Co. Portland, Oregon A Elk Creek Logging Co. Estacada, Oregon j/V. . M. Operating Co. Nehalem, Oregon John S. Brandis, Logger Corvallis, Oregon HDeep River Timber Co. Deep River, Washington j Oavis Logging Co. Cannon Beach, Oregon The enclosed Claimant Schedule must be filled out and returned to this office in order that the refund indicated on the above- named taxpayer's return is paid to the person legally qualified to collect such refund check. If an administrator or an executor has been appointed, a copy of the court certificate, showing the appointment of such officer and that he is still acting, must be attached to this schedule. If the estate has since been closed, a copy of the decree of distribution should be submitted. If no administrator has been appointed, it will be necessary for you to submit a copy of the certificate of death. No further action can be taken on the refund until this inforiiiation is submitted. IT:MP:meh -2- 7102199-47 Mr. Charles E. Larsen, Executor Estate of Mr. Silas Roy Moon April 15, 1947 In reply, kindly make reference to the symbols and number appearing in the upper left-hand corner of this letter. Very truly yours, Clarki Sjquire , pollec tor T. Woodworth j Chief, Income Tax Division End: STATE OF WASHINGTON j County of Clark I 3 fmfof (fottfrj, That on the c c d day erf / /h S? V/4 20 f* in the year of our Lord, one thousand nine hundred and Y? S ton /d/ lt; H rfyM/ryJlfo jSu l T/t rtS/' in the County and State aforesaid, I, the undersigned, y yj l t 7 (a f ., by authority of a License bearing date the* * * /jY- day oi/fQ rP/M j?X gt; Y A.D.. 194 5 . and issued by the County Auditor of Clark County, Washing 1ft limn m Carofttl XfoMark at y-y o'clock p.' m S '(US Oy-/m)QU o/ the County of /tjj) tfc State of lt;C Cf and /fytefQttk- S JAdJl A o/ the County o/ State o/ IN THE PRESENCE OF gt; --v r - l JC/ P XsQ fS gt;Q JCl CtJj9- ' gt; ' NAME OF PARTY PERFORMING MARRIAGE f * / WITNESSES ' * OFFICIAL STATION 7GROOM Signed: OkOOM Signed: M.OM AC 0- f J NOTE: Thf SC rtificat is *o b. given to contracting parties. FEDERAL SECURITY AGENCY Social. Security Administration NOTICE OF AWARD OF LUMP-SUM DEATH PAYMENT This refers to your claim for a lump-sum death payment under the Social Security Act. It has been determined that you are entitled to a single lump-sum death payment in the amount of the enclosed check. A claimant for old-age and survivors insurance benefits has a right to a reconsideration or hearing if he does not agree with the decision on his claim. Request for a reconsideration or hearing should be made promptly, not later than 6 months from the date shown on the face of the enclosed check, and should be made through the local office of the Social Security Administration. A widow receiving a lump-sum death payment may, under certain circumstances, become entitled to monthly insurance benefits upon filing an application at age 65. If you have any questions concerning your claim, you should get in touch with the field office where you filed your claim, or any other field office of the Social Security Administration. Joseph C. Columbus, Chief, Area Office, Bureau of Old-Age and Survivors Insurance, FornVS748 C121 ,o 18- 65i3h, 989 Market Street, San Francisco 3, Calif. * , Always give Claim No. 543-01-782 4-G1 when writing about this claim Silas R. Moon FEDERAL SECURITY AGENCY SOCIAL SECURITY BOARD Bureau of Old-age and survivors insurance Area Office Field Office San Francisco 11, Calif. Tacoma, Wash. Mr. Charles E. Larsen 1839 Fairbanks St. Tacoma 4, Washington July 21, 19 7 Dear Sir: This letter refers to your claim for a lump-sum death payment under the Social Security Act. It has been determined that you are entitled to a single lumpsum death payment of 78.02. A check for this amount will be sent to you by the Treasury Department within a few days. If you do not agree with this determination, you may request either that your claim be reconsidered by the Bureau of Old-Age and Survivors Insurance, or that a hearing be held on your claim by a referee of the Social Security Board. The request for a reconsideration or hearing should be made promptly and not later than six months from this date. If you have any questions about your claim, you should get in touch with your Social Security Board Field Office. Sincerely yours, jh aou L Chief, Area Office You -will be advised later as to your entitlement to the remainder of the lump sum. Form OA-CH88 (12-45) 16 33480 5 o. s. government printing office Claim No.543-01-7824-G1 Silas R. Moon 1839 E. Fairbanks Tacoma, Washington May 29, 1948 Social Security Board, Federal Building, Tacoma, Washington Gentlemen: - Under date of July 21, advising that my application for in the case of Silas R. Moon had it has been determined that you lump-sum death payment of 78.02. received. At the bottom of this 1947, the following was added: 1947 I received a letter a lump-sum death payment been acted upon and that are entitled to a single This amount has been letter, dated July 21, You will be advised later as to remainder of the lump sum,w your entitlement to the So far I have received no advice as to my entitlement to the remainder of the lump sum. Please advise. Yours truly, Charles E. Larsen * . IN THE CIRCUIT COURT OF Till? STATE OF OREGON FOR THE COUNTY OF MULTNOMAH. S.R. MOON, VS. MARGARET MOON, PLAINTIFF, DEFENDANT, 15729 DECREE. How on this day this matter coming on for hearing.the plaintiff appearing in perstfn and by his attorney, L.Cooper,the State of Oregon appearing,,by (j jU A-M4/ Deputy Distriot Attorney,and the defendant appearing riot,although default has been duly and regularly entered against her,and the court being fully advised is of the opinion that the plaintiff is entitled to a decree as prayed for in his complaint. IT IS THEREFORE CONSIDERED ORDERED AND ADJUDGED, that the bonds of matrimoney now and heretofore existing between the plaintiff and the defendant be, and are hereby dissolved,and held for naught,and that the plaintiff be restored to all the rights and privileges of a single and unmarre'ed person. lo-f? n ?A- hdQ* fr y JUDGE 3 QtA*l CHESTER E.M6CARTY WILLIAM L.DICKSON JAMES G.SWINDELLS WILLIAN tILLER McCarty Dickson Swindells ATTORNEYS AND COUNSELORS AT LAW YEON BUILDING PORTLAND A.OREGON March 1, 1947 in account with Mr. Charles E. Larsen 1509 H. St., S. E. Auburn, Washington SALEM.OREGON. fA-. 3 192 No. . 96-2 12 The TifrfcT National Bani IN SALEM s Pay to r * .. ,- *- 9 fc ?f 'Salem, QggGpN / - X 193 No.. . . w IN S.M.EM Pay to- The n T'NAliONAL Ban r . -t - 9 - rf- s- y- J3 u ** t- r Dollars yitV - / v* lt; p SAf/FMORFOON / **- I 193/ No. Th5 First National Bank . 96-2 12 in sa?.i 7 : * PAVTn * V gt; * lt;X . Vfl tyVfl-. ORORDER * l ' A .* /* * - y, A Dollars yirK' g-g7? ., lt; *..,., VVyJUr* OJLsi ,. ( J -Salem, Oregon Q y? ... Q . 19372 No The feistNational Bank 96-2 IN SaTiTm -, ** Pay to J gt; J lJ * / H V , U -QR order tU . 1 9 TV Q lt;0 W- X y - lt;JV, 2 -T : Dollars ''Sahem, Oregon. APRIL 11, 1S32 .193 No. *L Ray To. . The First National Banj IN a 9 mw 962 12 IN S *1 fiilfts R, Mot gt;n if r OftO DER 47 20.00 -Dollars 5 /X(fh Xy JUi SALEM,OREGON August 29, 1952 1Q3 The*First National Bank fHus 962 12 TO SALEM 1 i a- to I rfTffi1 t * H tie: and ,c./:lo 11 Uaoxx J r gt;s oi i gt;Kit 20.00 H .DOLLAHS Three Blocks From Union Depot Rates: 50c 75c 1.00 Large Lobby on First Floor Outside Rooms 3.00 Wk 12.00 Mo. Hot and Cold Water in all Rooms .. .. 4.00 Wk., 15.00 Mo. Steam Heat in all Rooms inside ., 2.50 Wk., 10.00 Mo. Arlington Hotel MRS. ANNA M. FOLEY. PROP. broadway 2907 Sixth and Flanders Sts. PORTLAND. OREGON d -y-3 3 -l C Sw Z* * S t f * -yfltfjlX-. TELEPHONE-BROADWAY 0168 L 3NG'diS ANCE--BROADW*Y 7974 STEAM HEAT FREE TELEPHONE HOT AND COLD WATER IN EACH ROOM ELEVATOR SERVICE STRICTLY FIRE-PROOF AND MODERN EVERY CONVENIENCE OWNERS PACIFIC COAST HOTEL CORP. THREE BLOCKS FROM NEW POST OFFICE FOUR BLOCKS FROM UNION DEPOT SIX BLOCKS FROM THEATRICAL AND SHOPPING DISTRICT ANNA M. FOLEY, MOR. Hotel Montana sixth and Everett Streets PORTLAND, OREGON gt;/U F/, la/ /f-yi cV lt; U*-ins gt;-6l*rtr* L' /deals 4- gt;*tA -*C J v-U lt; lt; gt; a tJuc fr / gt; y V rth lt;?L ZL X. AJ vU- - (iA-vJlCL ** - ,***. 4?ZLr X. Telephone-Broadway 0168 ng distance-broadway 7974 STEAM HEAT - FREE TELEPHONE HOT AND COLD WATER IN EACH ROOM ELEVATOR SERVICE STRICTLY FIRE-PROOF AND MODERN EVERY CONVENIENCE OWNERS PACIFIC COAST HOTEL CORP. THREE BLOCKS FROM NEW POST OFFICE FOUR BLOCKS FROM UNION DEPOT SIX BLOCKS FROM THEATRICAL AND SHOPPING DISTRICT ANNA M. FOLEY, MGR. Hotel Montana sixth and Everett streets PORTLAND, OREGON T lt;f FEDERAL SECURITY AGENCY SOCIAL SECURITY BOARD BUREAU OF OLD-AGE AND SURVIVORS INSURANCE INSTRUCTIONS TO APPLICANT FOR LUMP-SUM DEATH PAYMENT Please read carefully Those who may apply for such death payments and the order of their preference are shown below. If there is no surviving widow, child, or parent who would, upon filing an application, be eligible for monthly insurance benefits, the following persons are eligible to apply: 1st. Widow or widower; but if none, 2d. Child, children, or grandchildren who are children of a deceased child; but if none, 3d. Parents; but if none, 4th. Any person equitably entitled to repayment by reason of having paid burial expenses. The burial expenses must have been paid within 2 years of the date of the wage earner's death. There are attached (1) an Application for Lump-Sum Death Payment, and (2) Statement of Death. The application must be filed within 2 years of the date of the wage earner's death. To complete the application, write the information requested in each item. If you do not know an answer, write unknown. The application must be signed before a person authorized to administer oaths, such as a notary public. If you bring the forms to a field office representative, you will receive full assistance and the application may be sworn to without charge. Postmasters at third- and fourth-class post offices and rural mail carriers are also authorized to administer oaths free of charge. Proof of death. Proof of death of the wage earner must be supplied. The enclosed Statement of Death completed by the funeral director, or a copy of or statement as to the public record of death, certified by the person now in charge of such record, will be acceptable. If it is not possible to furnish one of the above because the wage earnsr died outside the United States, you should submit whatever proof you have. An official report of death from an officer in the military or naval service is acceptable. The official report will be returned to you upon request. Proof of adoption. // an adopted child of the deceased wage earner is applying or if the deceased wage earner is an adopted child of the applicant, a copy of the order of court or decree of adoption certified by the custodian of the record must be supplied. This certified copy can be obtained by a request addressed to the court which issued the order or decree. (OVER) Inst. OA-C8 16 43135-1 (1-45) Reimbursement. // applying for repayment of burial expenses paid from your funds you should submit an itemized, receipted bill signed by the funeral director, or other person to whom burial expenses were paid, showing any unpaid balance. The cost of the burial lot should be considered as part of the burial expenses except where (1) the wage earner had an interest in the lot (e. g., family plot), or (2) the lot was donated by someone else for the burial of the wage earner. If the wage earner had an interest in the lot, explain under Remarks ; if the lot was donated, give the name and address of the donor; if the lot was not donated, submit a receipted bill or a statement from the cemetery association showing its value and the name of the purchaser. If more than one person has paid burial expenses, the receipted bill should show the amount paid by each individual, and the amount remaining unpaid, if any. If it is reasonably convenient for you to call at this office, we shall be pleased to assist you in the completion of your claim. In the event you cannot call, please return the completed application and the required proofs, or an explanation of your inability to furnish such proofs, in the enclosed self- addressed envelope which requires postage. 16 43135-1 U. S. GOVERNMENT PRINTING OFFICE 7- s gt; FEDERAL SECURITY AGENCY SOCIAL SECURITY BOARD BUREAU OF OLD-AGE AND SURVIVORS INSURANCE IN REPLYING, ADDRESS: SOCIAL SECURITY BOARD FIELD OFFICE 123 U. S. Court House Seattle 4, Washington December 5, 1946 Mr. Charles Ka Larsen 1509 H. St., S.E. Auburn, Washington Wage Earner: Account No.: Silas Roy Moon 543-01-7824 Since you may be eligible for benefits based on yourtheabove wageearner's record, we are enclosing an application and pamphlet which outlines briefly the insurance payments authorized by the Social Security Act. If you wish to file a claim and will come to this office on any weekday except Saturday, we will be glad to help you in filling out your application or answer any questions you may wish to ask about the payment of benefits. If you are not able to come in, you may complete and mail the enclosed application and other forms to us. Instructions telling how to complete the application and forms are also enclosed. In order that you will not lose benefits for any month, your application must be filed with us no later than two years from the date of death. Sincerely yours. Manager Enclosures V Please send in itemized receipted statements for the buriel expenses and *-t a copy of the letter of administration. Xj * X /V -V' Bonn OA-CL/704 11-45 16 IM20-2 U. - GOVERNMENT PRINTING OFFICE bureau of old-age and survivors insurance area office: San Francisco 3, calif. FEDERAL SECURITY AGENCY SOCIAL SECURITY ADMINISTRATION ALWAYS GIVE CLAIM NUMBER WHEN WRITING ABOUT THIS CLAIM 5i3-0l-782A-G S. R. Moon June 17, 1948 Mr. Charles E. Larsen 1839 East Fairbanks Tacoma, Washington Dear Mr. Larsen: We regret that there will be a delay in furnishing the information you requested in your recent letter concerning your claim for insurance benefits under the Social Security Act, as amended, on the basis of the wage record of Silas R. Loon, deceased. Your claims folder has been sent to our central records office for review. When it is returned, you will be notified of the action taken in your case with respect to further benefits payable to you on the basis of Mr. Moon's wage record. Very truly yours, g. aJ j (Joseph C. Columbus Chief, Area Office Always give Claim No. 543-01-7824.-G . .jnhen writing about this claim S. R. Moon FEDERAL SECURITY AGENCY SOCIAL SECURITY ADMINISTRATION Bureau of Old-Age and Survivor Insurance 9 Area Office San Francisco, Qalif. Field Office Tacoma, Wash. *, July 26, 1948 l Mr* Charles E. Larsen 1839 Fairbanks St. Tacoma J+t Wash. Dear Sirs This letter refers to your claim for a lump-sum death payment under the Social Security Act. It has been determined that you are entitled to a single lump-sum death payment of f 60.15 A check for this amoilht will be sent to you by the Treasury Department within a few days. If you do not agree with this determination, you may request either that your claim be reconsidered by the Bureau of Old-Age and Survivors Insurance, or that a hearing be held on your claim by a referee of the Social Security Administration. The request for a reconsideration or hearing should be made promptly and not later than 6 months from this date. If you have any questions about your claim, you should get in touch with your Social Security Administration Field Office. It has been determined that you Sincerely yours, are'entitled to the additional amount shown above which is the remainder of the lump-sum payment referred to in our previous letter. Chief, Area Office fOO. oincerexy yours, Form OA-CIA88 (10-46) 16 33480-6 U C. GOVERNMENT PRINTING OFFICE