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[[preprinted]] Application-Bladensburg Union. CITY OR TOWN:|STATE:|MONTH:|DATE:|YEAR:| [[/preprinted]] [[dotted underline]] Riverdale| Md| Dec| 4| 1911 [[/dotted underline]] [[preprinted italics]] I hereby make application for admission into the Bladensburg Union. Age last birthday [[dotted underline]] ^[[23]][[/dotted underline]] years. [[/preprinted italics]] [[dotted underline]] ^[[signature]] Flora M. Scott. [[/dotted underline]] [[/signature]][[preprinted italics]] Name of Applicant. [[/preprinted]] [[/dotted underline]] ^[[$1. bal due $4. Paid W.E.B]] [[double line]] [[preprinted italics]] This certifies that the above named applicant is in reasonably good health. [[/preprinted italics]] [[dotted underline]] ^[[signature]] Not given [[/signature]], M.D. [[/dotted underline]]
Transcription Notes:
Same card as Page 36 scanned twice...