TEXAS STATE BOARD OF HEALTH
BUREAU OF VITAL STATISTICS
STANDARD CERTIFICATE OF DEATH

1. PLACE OF DEATH: County Wilson
                   City: Stockdale
2. FULL NAME: William L. Peak
Length of residence in city or town where death occurred: 4 years 3 months 10 days


PERSONAL AND STATISTICAL PARTICULARS

3. SEX: Male
4. COLOR OR RACE: white
5.SINGLE, MARRIED, WIDOWED OR DIVORCED
     married
6. DATE OF BIRTH: January 9, 1870
7. AGE: 64 years 2 months 21 days
8. OCCUPATION: Farmer
9. BIRTHPLACE: Rockwood, Rhone {Ed: this should be spelled Roane} Co., Tenn.
10. NAME OF FATHER: Luke Peak
11. BIRTHPLACE OF FATHER: Tennessee
12. MAIDEN NAME OF MOTHER: Nancy Ballew
13. BIRTHPLACE OF MOTHER: Tennessee
14. THE ABOVE IS TRUE: (Endorsement) Mrs. William L. Peak, (Address) Galena Park, Texas
15. Filed: {left blank}


MEDICAL PARTICULARS

16. DATE OF DEATH: March 30, 1934

17. I HEREBY CERTIFY, That I attended deceased from 
Sept. 1933 to March 30, 1934  
that I last saw him alive on March 30, 1934 
and that death occurred on the date stated above, at 8:30 A.M.

The CAUSE OF DEATH* was as follows: Chronic Myocarditis
  (duration) ____yrs. ____mos. ____days
Contributory (Secondary) {left blank}
  (duration) ____yrs. ____mos. ____days
  
18. Where was disease contracted if not at place of death? {left blank}
Did an operation precede death? {left blank}
What test confirmed diagnosis? {left blank}
(Signed) H. B. May, M. D., (Address) Stockdale, Texas

* State the Disease Causing Death, or in deaths from Violent Causes,
state (1) Means and Nature of Injury, and (2) whether Accidental,
Suicidal, or Homicidal.

19. PLACE OF BURIAL OR REMOVAL: Stockdale, Texas
DATE OF BURIAL: March 31, 1934

20. UNDERTAKER: E. H. Salmon & Son
ADDRESS: Stockdale, Tex 




==================================================
Transcription copyright © RoaneTNHistory.org 2008. 
All rights reserved.

Archivists:
Transcription by G. Anne Sloan and C. Sloan.
Scan by Bill Peak.