Transcribed death certificate of John G. PEICH

Contributed for use in the USGenWeb Archives by Connie
Nelson  <  csnelson@ticon.net  >

USGENWEB NOTICE:  In keeping with our policy of
providing free genealogy information on the Internet, data
may be freely used by non-commercial entities, as long as
this message remains on all copied material.  These electronic
pages may NOT be reproduced in any format for profit or
presentation.  Individuals or organizations desiring to use
this material for purposes other than as stated above, must
contact the submitter or the listed USGenWeb archivist.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 

STATE OF WISCONSIN
DEPARTMENT OF HEALTH-BUREAU OF VITAL
STATISTICS
COPY OF DEATH RECORD

Obtained from Walworth County Courthouse, Courthouse
Square, P O Box 1001, Elkhorn, Wi.  53121
Walworth County deaths, Volume 19, page 99

JOHN G. PEICH

1. Place of death      County of:  Walworth 
      City of:  Whitewater (No. Chicago 805 St., 1st Ward)
2. Full name:  John G. PEICH
a) Residence No:  805 Chicago St., 1st Ward
Personal and statistical particulars
3. Sex:  male
4. Color or Race:  White
5. Single, Married, Widowed, or Divorced:  Married
a) If Married, Widowed, or Divorced, Husband of: Married Husband
6. Date of Birth:  December 10th, 1848
7. Age: 73 years, 5 months, 23 days
8. Occupation
a) Trade, Profession, or Particular Kind of Work: Retired Farmer
b) General Nature of Industry, Business, or Establishment in
Which Employed (or Employer):  --------
9. Birthplace:  Germany
10. Name of Father:  Samuel Peich
11. Birthplace of Father:  Germany
12. Maiden Name of Mother:  Minnie Machlin
13. Birthplace of Mother:  Germany
14. Informant:  Arthur Peich
15. Filed:  June 3, 1922       G.H. Fay, Registrar
16. Date of Death:  June 2, Fri. 1922
17. I HEREBY CERTIFY, That I attended the deceased from May 1,
1922, to June 2, 1922, that I last saw him alive on May 29, 1922
and that death occurred on the date stated above, at 4 a.m.
The CAUSE OF DEATH was as follows:  Organic Heart Disease; 
Chronic Eridocaidity (?)
18. Where Was Disease Contracted, if Not at Place of Death?: ---
(Signed)  John W. Dunn, M.D.        June 3, 1922
(Address) Whitewater, Wis.
19. Place of Burial, Cremation or Removal:  Hillside Whitewater
Date of Burial:  ------
20. Undertaker:  Cummings & Hicker   Address:  Whitewater
236557  Filed:  July 14, 1922     F.G. Holmes, Register of Deeds