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| caption =
| caption =
| birth_name = <!-- only use if different from name above -->
| birth_name = <!-- only use if different from name above -->
| birth_date = <!-- {{birth date and age|YYYY|MM|DD}} -->
| birth_date = {{birth date and age|1897|10|09}}
| baptism_date =
| baptism_date =
| birth_place =
| birth_place =
| disappeared_place =
| disappeared_place =
| disappeared_status =
| disappeared_status =
| death_date = <!-- {{death date and age|YYYY|MM|DD|YYYY|MM|DD}} (death date then birth date) -->
| death_date = {{death date and age|1970|12|03|1897|10|09}}
| death_place =
| death_place =
| death_cause =
| death_cause =