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[[preprinted]]
Application-Bladensburg Union.
^[1928]]
City or Town: State: Month: Date: Year:
^[[St. Patricks, Grenada, B. W. I. - August 7, 1887 [[?]]on]]
I hereby make application for admission into the Bladensburg Union.
Age last birthday ^[[42]] years.
[[signature]] ^[[Bartholomew Aberdeen [[checkmark]] ]] [[/signature]]
Name of applicant.
[[double line]]
This certifies that the above named applicant is in reasonably good health.
[[signature]] ^[[Charles B Frisky[[guess]]]] [[/signature]] , M. D. 
[[/preprinted]]