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Manual of the Mother Church - The First Church of Christ Scientist in Boston, Massachusetts by Mary Baker Eddy
page 67 of 86 (77%)
My teacher in Christian Science is
...............James B. Brown, C.S.D. ..................

I am not a member of any church.


FORM 1--(Continued)

I was formerly a member of the .............................
............ denomination, but have definitely severed my
connection therewith.

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, ..........
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