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From transcribe
- Name in full Mrs Champion Annie Ethel
- Date of birth Day 23 Month 08 Year 1890
- Place of birth Assiniboa NWT
- Maiden name Dawson
- Husband’s given names Richard William
- Wife’s full maiden name Annie Ethel Dawson
- Father Dawson William John
- Mother Russell Mary
- Given names of brothers or sisters Ernest Claude Ada Marjorie
