(FOR INSTRUCTIONS SEE BOTTOM OF SHEET.) STATE OF MINNESOTA County of Otter Tail [â€œssâ€ abbreviation for sworn statement] (A.) Jacob Austin being duly sworn, says that he resides in the town of Fergus Falls, Minn in the County and State aforesaid, that he was personally acquainted with (B.) William Tims in his lifetime, and that on or about the 8th day of January, 1873, the said William Tims was frozen to death; that the deceased immediately preceding his death resided in said town, and his body has since been found dead in the town of Fergus Falls, Minn . That a team of Mules belonging to the deceased, and of the value of $200 (besides 1 head of (C.) cow owned by him, and of the further value of $50 ) died from the effects of said storm. That the age of the deceased was 32 years, and he died leaving a family of a wife and ---- children whose respective names and ages are as follows, viz: (D.) Margaret Tims The deceased died owning homestead 160 acres of real estate, worth over and above all encumbrances, $600 and the following personal property, (not including the live stock above described as lost,) viz: 300 bushels of grain worth $115 ; 1 mule horses worth $100 ; two head of horned cattle worth $40 ; hay and feed worth $ ; provisions for the family worth $ ; household goods and clothing worth $50 ; fuel, and all other personal property of the value of $ The family of the deceased have provisions sufficient to support them months, and fuel to last one week (E.) The wife Margaret Tims froze her feet and legs so bad as to be oblige[d] to have them amputated just below the knee; She also froze he[r] hand very bad, making it necessary to take out the knuckles. (F.) Jacob Austin Subscribed and sworn to before me, this (seal) 24th day of February 1873. D. P. Hatch Notary Public INSTRUCTIONS (A.) Write name of person making oath. (B.) â€œ â€œ deceased. (C.) Horses, cattle or hogs, as the case may be. (D.) Give name and age of each. (E.) If any member of the family is sick or disabled, or there are any other circumstances material to a full understanding of the case, write them out in the blank following (E.) The affidavit must be sworn to by two creditable persons, one signing on the line marked (F.) the other witnesses signing on the other side of this sheet. The persons making the affidavit, if not members of the family, should be those best acquainted with the facts. The officer administering the oaths, if he has the knowledge, and if not, the postmaster of the town, or one of the county officers who knows the facts, should then sign the certificate, endorsed on the back hereof. The affidavit, with letters giving further particulars, if necessary, should then be mailed or sent to the Governor.