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[[preprinted]] Application-Bladensburg Union. CITY OR TOWN: STATE: MONTH: DATE: YEAR: ^[[Hyattsville, Md. July 7, 1913]] I hereby make application for admission into the Bladensburg Union. Age last birthday ^[[6]]years. ^[[$2]] ^[[signature]] ^[[Paul Jeremiah Johnson]] [[/signature]] Name of Applicant. [[double line]] This certifies that the above named applicant is in reasonably good health. ^[[signature]] ^[[Matthew V.S. Lee]] [[/signature]], M.D. [[/preprinted]]