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From transcribe
- Name in full Mrs Cusworth Evelyn Beatrice
- Date of birth Day 28 Month 11 Year 1896
- Place of birth Nanaimo BC
- Husband's given names Clifford Cusworth
- Wife's full maiden name Evelyn Beatrice Stevens
- Father Stevens Charles Godwin
- Mother Marsh Hannah
- Given names of brothers or sisters Justina Beda Hannah Matilda Charles Godwin Edith Gertrude
