Fel. 3Uu Stuckel, :Mrs . Herbert F. (Flora) --------------------- '1:85 - ::l!i. bafl -- 8t:rest ,--- Buf . 8 - - ------ ---------------------- 6~% W. kr. I CMhead A ll'e •Kerutewiek h Wash • I I Thayer Ave., Richland, Was . ~ (Applicant will please not write in spaces above this heavy line)

Home G_d, 58%)


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

Delaware Avenue Baptist Church - Buffalo, N. Y.

D By Baptism ~ By Letter from

The United Church of Canada, Neepawa, Manitoba

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

D By sprinkling

My name In full ----------------------------------- (If married woman give first name also)

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


Occupation ------------------------–

Home _______

Business Address



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