Robertr R RedfieldEM
ORIGINAL
OFFICIAL FORM OF TRANSIT PERMIT
ISSUED BY TEXAS STATE BOARD OF EMBALMING
- ----- - -- - - ------ - ---- - ---- - - - --------------------------- - -- ---------------------- nAxinoAn
PHYSICIAN'S OR CORONER'S CERTIFICATE
San Antonio------Bexar --------- ---------- --- -TEXAS
----- - --------------------------- - -------------- - ----- --------------------------------------------- ---- --- --- --- ---------------------------------------- --- ------------ ------- - --------------------- -
CITY COUNTY
(If death occurred In a
Mr. TZobert R. Redfield- " CoUntY Tail ........................ hospital or institution,
2 PULL NAME ---- - -- - ---- - ------ - - --- - ------ --- --------- --- --------- -give its NAME instead
Hospital Street Ward of street and number, and
fill out Nos. 17a and 17b.)
PERSONAL AND STATISTICAL PARTICULARS MEDICAL CERTIFICATE OF DEATH
3 SEX1 4 COLOR or RACE 1.5 Single, Married, widowed or 15 DATE OF DEATH
Divorced. (Write the word) TT31 ------------------------------ - -- iq_ ----- 4 - 2
White Married (Month) (Day) (Year)
:4 5a if married, widowed, or divorced 16_ I HEREBY CERTIFY, That I attended deceased from
4� HUSBAND of Airs. Tewel Medfield--------
9 (or) WIFE of - -- ------------
6 DATE OF BIRTH that I last saw..,h __alive on________ _ __ ---___ - --------- 19 --------
-- - — -------------- - - ----------- --- ------------- ---- --------- ------ - - 19-02---P'19 Alm
(Month) (Day) (Year) and that death occurred on the date stated above
AGE The CAUSE OF DEATH* was as follows.____ _- ------ - ------ - - -- - --------
d knot' Ii natural cau-s-9 ---------- ---------- --------- ---------------------- - ---------- 40 ------------- --------- - ------- Months
8 OCCUPATION
(a) Trade, profession, or Clerk
particular kind of work__--______ --- ----------- ---------------------- ------------
(b) General nature of industry,
business, or establishment in
which employed (or employer) ------ ----- -- --- ----- -- --- ----------------
9
------ -9 BIRTHPLACE
(State or county, Nebraska
U city or town)
10 NAME OF
FATHER E.
B. Redfield
57 M 11 -EXETHPLACM OF FATHER
E4 (State or County) Conn.
12 MAIDEN NAME
Or MOTHER unk
P,
13 BIRTHPLACE OF MOTHER
-(State or County) unk.
p., I'la 1.X;Kq*wU OF RESIDENCE 8 yrs. in S -�,ntoi,
How long in U. S., if of foreign birth? ------ years ------ months ----- days
,
k 14 The Above Is True to the Best of My Xnowledge
(Informant) - ----- J4)r_s,__2EewQlRqd_Lield - ------
__ , .1 - A __ , __ 2 - ii7..-
(Duration)__ ---------- years ------------ mo1iths__________days
Contributory--------------------- - ---- ------------- -- ---------------------------- --------- - - ----- -----
- ---------- - ----- (Duration)___:_ - - - yeans --- - ---- - --- months ---- days
CAUSES, state (1) Means of Injury; and (2) whether (probably)
17b Where was the disease contracted
ifnot at place of death?---------------- ---------------------------- ---------
Did an operation precede death? - ----- -- - ---- date of___--_____-________
Was
f----------------------
Was there an autopsy?--------- -------------------------------------------------
What test nfirme dia sis? ------ - ---------------------- - ---------- - ---
* disease" the diseascausing death, or in deaths from violent
causes, state (1) Means and nature of injury, and (2) whether
accidental, suicidal, or homicidal.
IS Place of Burial or removal Date of Shipment
Blair, Nebraska 17'uly 30, 19421s_____. - - _ ..
t9 Undertaker Address
Akers Funeral Home I 441 will Ave.,
--- A_�' - M_
TRANSPORTATION PERMIT
This Permit must be properly signed, and with Physician,s Certificate presented to the Railroad or Express Agent before a body can
be shipped.
Permission is hereby granted ------------------- Ma -r -t 1
_-F.—Ki _C_�ge ---------------------- under Embalmer's License No. -1169
to remove for burial the body of the above described person from ---------- San Antonio ----------------------------------------------- Texas,
(city) (County)
Blair Washington Nebraska
to-- ------------------------- --------------- - -- ---------- ------------ --------------------------------- ---------- ----------- --------------------
(City) (County) (State)
and____________ '�r ______________________________-_.--____is hereby granted authority to accompany said body.
L
Officer
Texas
Rule 70. No body of any person dead of Asiatic cholera, bubonic plague, smallpox, shall be transported,, except in a hearse or U,el
taker's wagon. unless said body shall have been cremated.
The upper half of this sheet must be detached at this perforation and handed to the passenger in char-