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| caption =
| birth_name = <!-- only use if different from name -->
| birth_date = <!-- {{Birth date and age|YYYY|MM|DD}} 或 {{Birth year and age|YYYY}} [[WP:DOB]]. {{Birth date|YYYY|MM|DD1964}}. -->
| birth_place =
| death_date = <!-- {{death_date_and_age|1916|1|7|1908|4|10|mf=y}} -->