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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 ^[[43]] years.  
^[[$2]]
^[[signature]] ^[[(Mrs.) Ida Dunnington]] [[/signature]]
Name of Applicant.  
[[double line]]
This certifies that the above named applicant is in reasonably good health. 
^[[signature]] ^[[Mattie V.S. Lee]] [[/signature]], M.D. 
[[/preprinted]]