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[[preprinted]] Application - Bladensburg Union. City or Town: State: Month: Date: Year: ^[[Takoma Park, Md. Sept. 8, 1913.]] I hereby make application for admission into the Bladensburg Union. Age last birthday ^[[17]] years. ^[[$1]] [[signature]] ^[[(Miss) Helen Peach Brown]], [[/signature]] Name of Applicant. [[double line]] This certifies that the above named applicant is in reasonably good health. [[signature]] ^[[Mattie [[?]] T. Lee]] [[/signature]] , M. D. [[/preprinted]]