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From transcribe
- Name in full Mrs Black Emma Samson
- Date of birth Day 26 Month 10 Year 1892
- Place of birth Fergus Ontario
- Maiden name Mills
- Husband’s given names Hubert John
- Wife’s full maiden name Emma Samson Mills
- Father Mills Thomas Brown
- Mother Samson Agnes
- Given names of brothers or sisters Lawrence Imrie James Kenneth Brown
