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[[preprinted]] Application - Bladensburg Union. City or Town: State: Month: Date: Year: ^[[Hyattsville Md Feb 10 1914]] I hereby make application for admission into the Bladensburg Union. Age last birthday ^[[46]] years. ^[[$1.]] [[signature]] ^[[Joe Dunnington]] [[/signature]] Name of Applicant. [[double line]] This certifies that the above named applicant is in reasonably good health. [[signature]] ^[[H. T. Willis]] [[/signature]] , M. D. [[/preprinted]]