1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: 5307
Inc Town: Cloverport, Ky
City:
No.
St.
Ward: 3rd
Registration District No.: 131
Primary Registration District No:
File No. 11891
Registered No: 64
1. FULL NAME: George H Keech
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: colored
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: single
5. DATE OF BIRTH: Dec 5, 1898
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 13yrs5mos25ds
7. OCCUPATION (a.) Trade, profession or particular kind of work: At school
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Breckinridge Co, Ky
9. NAME OF FATHER: Phillip Keech
10. BIRTHPLACE OF FATHER: Ky
11. MAIDEN NAME OF MOTHER: Hattie Bridwell
12. BIRTHPLACE OF MOTHER: Breck Co, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Hattie Steward (Stewart)
(Address) Cloverport, Ky
14. Filed May 31, 1912
REGISTAR: JC Nolte
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: May 30, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): May 20, 1912 to May 30, 1912
That I last saw him/her alive on (date): May 20, 1912
And that death occurred on the date stated above at (time AM/PM): 10:30 PM
THE CAUSE OF DEATH was as follows:
Tubercular Meningitis
(Duration)
Years:
Months:
Days: 20
Signed (M.D.): E.C. McDonald
Date: May 31, 1912
Address: Cloverport, Ky
17. LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):
In the State (yr, mo, da):
Where was disease contracted,  if not at place of death?
Former or usual residence:
18. PLACE OF BURIAL OR REMOVAL: Locust Hill Cemetery, Cloverport, Ky
DATE OF BURIAL: June 1, 1912
19. UNDERTAKER: M Hamman Sons
ADDRESS: Cloverport, Ky