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I WISH to enter into active Christian Service by becoming a member of

Delaware Avenue Baptist Church - Buffalo, N. Y.

D By Baptism

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Fi rst Bap tist , Endicott , NY

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D By Christian Experience

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Method of my baptism : D By immersion

D By sprinkling

My name in Juli - - ------------------------------ ---- (If married woman give first name also)

Address -------------- - -------------------- Zone__


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

Home _ _______

Business Address Date J anua ry 31 , J 251


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