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[[image - pair of hands in handshake]] [[preprinted]] Application Blank - Bladensburg Union I hereby make application for admission in the Bladenburg Union. Name ^[[Flossie M. White]] Street ^[[4244 Clay St. N.E.]] City or State ^[[Washington D.c.]] Age last birthday ^[[49]] Month ^[[December]] Year ^[[1898]] Beneficiary ^[[Marion Odessa White]] 1. Voucher [[signature]] ^[[John G. Walker]] [[/signature]] 2. Voucher [[signature]] ^[[Ida S. Burke]] [[/signature]] [[double line]] This certifies that the above-named applicant is in good health. ^[[$5.00]] [[signature]] ^[[Edwin L. Williams S.]] [[/signature]] M. D. [[/preprinted]]