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Reg . ' 4059

·Potter, - Dorothea Louise <.. ~.sv-o ----1-48 H ambo l ctt····pitwy······························································ Buffalo ~,r4f . Y. P-/ D I ':f _

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

Delaware Avenue 8aptist Church - 8uffalo. N. Y. 4/15/62 D By Letter from - - --- ------------------------- ----- [j By Baptism

0 By Christian Experience

D By sprinkling

Method of my baptism :

By immersion

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My name in full ~/__

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TELEPHONES

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