Name ………….. Mrs. Jennie W. Field, C.S. ……….
Street and Number ……. 18 Forest St., …………….
Town or City ……………. Chicago, ………………
State ………………………. Ill ………………
Date …………….. Jan. 2nd, 1901 ……………….
I cordially approve the applicant.
(a) …………… James B. Brown, C.S.D. ……………
Countersigned by ……………………………………
DO NOT DETACH.
To the applicant: Name …… Mrs. Jennie W. Field, C.S. …… Please fill out the Street and Number … 18 Forest St., …….. following for the use Town or City ………… Chicago, ………. of the Treasurer of State ………………………. Ill …… the Church:
Application I
PROPERLY SIGNED AND ENDORSED,
ACCORDING TO ARTICLE V, SECT. 2
If you have been taught by a loyal student who has taken a degree at the Massachusetts Metaphysical College, or by one who has passed an examination by the Board of Education, fill this blank.