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[[preprinted]]
Sick Certificate of the Bladensburg Union.

City or Town: ^[[Washington]]
State:  ^[[DC]]
Month: ^[[11]]
Date: ^[[15]]
Year: ^[[1930]]

This certifies that ^[[Mrs Fr[[?]] Muller]] is sick with ^[[acute appendicitis]], and under my professional care.

^[[E C Cag[[?]], M.D.
[[double line]]

Chairman of Sick ^[[W. R. Davis]]

Was taken ^[[Nov 5, 1930]]
[[/preprinted]]