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~y Baptism Delaware Avenue BaptistCh~r · Buffalo,J. Y. 190 9 ('?~ j(j ~ D By Letter from _ ___ _ _______________ ______::::.___________

D By Christian Experience

D By sprinkling

Method of my baptism : [21'..By immersion

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

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Address-------------------- - ---------- - - -

TELEPHONES

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

Home _____ ___

Business Address

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