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[[boxed]]
[[/preprinted]]
Will Blank
... The Bladensburg Union...
Bladensburg, Md.

^[[6-7]] 19 ^[[38]].

I ^[[Mary Newloń]] 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 ^[[Aunt]]
(Relative or Friend)

[[signature]] ^[[Mrs. Flora M Martin]] [[/signature]]
Name of Beneficiary)

Philip Broome, Pres.
William E. Burke, Sec.
[[/preprinted]]
[[/boxed]]