Viewing page 26 of 236

This transcription has been completed. Contact us with corrections.

[[preprinted]]
Application-Bladensburg Union.
City or Town: State: Month: Date: Year:
^[[Hyattsville Md Aug 3 1914]]
I hereby make application for admission into the Bladensburg Union.
Age last birthday ^[[22]] years.
[[signature]] ^[[Shirley Fortune]] [[/signature]]
Name of applicant.
[[double line]]
This certifies that the above named applicant is in reasonably good health.
[[signature]] ^[[H T Willis]] [[/signature]] , M. D. 
[[/preprinted]]