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From transcribe
- Name in full Mr Burgess Herbert Arthur
- Date of birth Day 08 Month 10 Year 1896
- Place of birth Whitewood Sask
- Maiden name Martin Lillian Alice
- Husband’s given names Herbert Arthur
- Wife’s full maiden name Martin Lillian Alice
- Father Burgess Joseph
- Mother Dale Jennie
- Given names of brothers or sisters Margarite May James William Jessie Jane
