1. PLACE OF DEATH
County: Breckinridge
Vot. Pol.: Rockvale
Inc Town:
City:
No.
St.
Ward
Registration District No.: 5320
Primary Registration District No:
File No. 27057
Registered No: 9
1. FULL NAME: William W. Leach
PERSONAL AND STATICAL PARTICULARS
2. SEX: male
3. COLOR OR RACE: white
4. SINGLE, MARRIED, WIDOWED, OR DIVORCED: married
5. DATE OF BIRTH: August 11, 1864
6. AGE  (yr. mo. da) (If less than 1 day, hours or min?): 48yrs3mos17ds
7. OCCUPATION (a.) Trade, profession or particular kind of work: farmer
(b.)  General nature of industry business or establishment which employed:
8. BIRTHPLACE: Ohio Co, Ky
9. NAME OF FATHER: Joseph Leach
10. BIRTHPLACE OF FATHER: Ohio Co, Ky
11. MAIDEN NAME OF MOTHER: Kittie A. Kinsell <Kendall>
12. BIRTHPLACE OF MOTHER: Ohio Co, Ky
13. THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant) Willie E Leach
(Address)Vanzant, Ky
14. Filed 11/28/1912
REGISTAR: J.D. McDonough
MEDICAL CERTIFICATE OF DEATH
15. DATE OF DEATH: Nov 28, 1912
16. I HEREBY CERTIFY, That I attended deceased from (date): on Nov 28th, 1912—was called to see this man who was dead when I arrived
That I last saw him/her alive on (date):
And that death occurred on the date stated above at (time AM/PM):AM
THE CAUSE OF DEATH was as follows:
Organic heart lesion…………………from the <   > I could learn by unassociation & inpoveration
(Duration) Suddenly
Years:
Months:
Days:
Signed (M.D.): M.O. Robertson
Date:
Address: Glen Dean
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: Leach Burying Ground
DATE OF BURIAL: 11-30-1912
19. UNDERTAKER: WW Hatler
ADDRESS: Rosine, Ky