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

City or Town: ^[[New York]]
State: ^[[New York]]
Month: ^[[July]]
Date: ^[[17]]
Year: ^[[1930]]

This certifies that ^[[Mrs Rosa Brooks]] is sick with ^[[Acute plastic pleurisy]], and under my professional care.

^[[Albert H. Armstrong]], M.D.
[[double line]]

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

Was Taken ^[[July 3, 1930]]
[[/preprinted]]

Transcription Notes:
Seriously, the information is all there and presented as the form is printed. Why would anyone just change to suit their version of what is appropriate??? I don't understand!!