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[[preprinted form]] Application - Bladensburg Union. CITY OR TOWN: ^[[Hyattsville]] STATE: ^[[Md.]] MONTH: ^[[Oct]] DATE: ^[[3.]] YEAR: ^[[1910.]] I hereby make application for admission into the Bladensburg Union. Age last birthday ^[[18.]] years. ^[[Addie F Hammond.]] Name of Applicant. ^[[$1.tal.due$4: Paid WEB.]] [[double line]] This certifies that the above named applicant is in reasonably good health. ^[[not given.]], M. D. [[/preprinted form]]