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[[preprinted]]
Sick Certificate of The Blandensburg Union.
[[line]]

City or Town: [[blank]]
State: [[blank]]
Month: ^[[Sept]]
Date: ^[[10"]]
Year: ^[[1926]]

This certifies that ^[[Mrs. Virginia Jackson]] is sick with ^[[Burn of left arm]] , and under my professional care. 

^[[James J. Blue]], M.D.

Was taken ^[[August 12" 1926,]]

^[[H. R. Davis.]] Chairman of the Sick.
[[/preprinted]]