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[[preprinted]] Application-Bladensburg Union. City or Town: State: Month: Date: Year: ^[[Bladensburg Maryland Feb. 24 1914.]] I hereby make application for admission into the Bladensburg Union. Age last birthday ^[[thirty-seven]] years. ^[[$1]] [[signature]] ^[[Thomas A Wheeler.]] [[/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]]
Transcription Notes:
Not sure if it's H.T. or H.J. Willis
(Its H. T. Willis)