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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]]