N _ J~~_g_.___ J_9.Q7________ ~i:,~~J~., Hrs _.____Harold__ L_. _______ -~· _ft:t ~---~------------------------·-· 42 Edgewood Street, Kerr:wFe 23 1?

Home Im hl18'.,

20 Girard St., Rochester 10, N. Y.


~ (Applicant will please not write in spaces above this heavy line)

I WISH to enter into active Christian Service by b ecoming a memb er of

Delaware Avenue Baptist Church - Buffalo, N. Y.

D By Baptism [X By Letter from __ F_i_r_s_t _ Ba_o_t_1_·s_t~,__ Bu_f_f_a_l_o___________________

D By Christian Experience Method of my baptism : D By immersion

D By sprinkling

'1- - ':I -s- My name in full ---,--- -------------------------- ---– (If married woman give first name also)

Address ----------------------------------- Zone___


Occupation ---------------------------–

Home ________

Business Address

Date __ }~1a=r~c1_1~1=9......,._,


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