This transcription has been completed. Contact us with corrections.
[[preprinted]] Application-Bladensburg Union. City or Town: State: Month: Date: Year: ^[[Hyattsville Md. Aug 1 1910.]] I hereby make application for admission into the Bladensburg Union. Age last birthday ^[[4.]] years. ^[[75 45 [[line]] 20]] [[signature]] ^[[Dorothy. P. Johnson.]] [[/signature]] Name of applicant. ^[[50c. bal due $2. Paid W.E.B. [[double line]] This certifies that the above named applicant is in reasonably good health. ^[[Not given]] , M. D. [[/preprinted]]