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[[preprinted]] Application - Bladensburg Union. City or Town: State: Month: Date: Year: ^[[51 - C St., S.W., Washington, D.C. Sept. 8, 1913.]] I hereby make application for admission into the Bladensburg Union. Age last birthday ^[[4]] years. ^[[$1]] [[signature]] ^[[Theodore Hill.]] [[/signature]] Name of Applicant. [[double line]] This certifies that the above named applicant is in reasonably good health. ^[[Oct 4th 1913]] [[signature]] ^[[J. D. Blair]] [[/signature]] , M. D. [[/preprinted]]