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[[boxed]] [[preprinted]] Will Blank ... The Bladensburg Union... Bladensburg, Md. ^[[April 3]] 19 ^[[50]] I ^[[Philip W. Broome Jr.]] 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]] (Relative or Friend) [[signature]] ^[[Margaret J. Broome]] [[/signature]] (Name of Beneficiary) Philip Broome, Pres. William E. Burke, Sec. [[/preprinted]] [[/boxed]]