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