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From transcribe
- Name in full is Mr. Plimley Thomas Horace
- Date of birth Day 25 Month 03 Year 1895
- Place of birth Victoria, B.C.
- Maiden name
- Husband's given name
- Wife's full maiden name
- Father Plimley Thomas John
- Mother Harris Rhoda
- Given names of brothers or sisters William Percival Plimley, Rachel Grace Kingham (Mrs. J.R. Kingham)