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From transcribe
- Name in full Mr Burgess Henry Lloyd
- Date of birth Day 05 Month 05 Year 1885
- Place of birth Burgessville Ont
- Wife's full maiden name Mary Ella Watt
- Father Richard Leonard Burgess
- Mother Ella Burgess
- Given names of brothers or sisters Richard L
- Jessie M Ladner Annie Laurie Edna
