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[[boxed]]
[[preprinted]] 
WILL BLANK
... The Bladensburg Union...
Bladensburg, Md.

[[stamped]] JUL 14 1938 [[/stamped]]

^[[July-14]] 19 ^[[38]].

I ^[[Chas. T. Mitchell]] hereby request that One Hundred Dollars (100.00) furnished by the Bladensburg Union upon the death of an adult member for funeral expenses to be paid to my ^[[Wife & Sister $75.00]]
(Relative or Friend) 

^[[For nter Funeral $25.00 goes to Name [[?]] ]]

[[signature]] ^[[Chas. T. Mitchell or Mr [[?]] J.W. Wathier[[?]] ]] [[/signature]]
(Name of Beneficiary)

Philip Broome, Pres.
William E. Burke, Sec.

[[Circular seal, embossed once]] 
THE BLADENSBURG UNION
FOUNDED 1870
MARYLAND 
[[/seal]]
[[/preprinted]]
[[/boxed]]