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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 ^[[4]] years. ^[[$1]] [[signature]] ^[[Sonise Plummer Moss,]] [[/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]]
Transcription Notes:
Name might be Louise rather than Sonise