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<center>''Notary Public.''</center>
 
<center>''Notary Public.''</center>
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{{Vertical space|}}
    
<div style="border-bottom: 2px solid black; width: 8em; margin: 0 auto;"></div>
 
<div style="border-bottom: 2px solid black; width: 8em; margin: 0 auto;"></div>
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{{Style S-Lost|}} ''to Helen P. Blovatsky''
 
{{Style S-Lost|}} ''to Helen P. Blovatsky''
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{{Style S-Lost|302.10.47}}
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''{{Style S-Lost|302.10.47}}''
    
''New York City''
 
''New York City''
 
|}
 
|}
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<p style="font-size: 70%; text-indent: 0;">Five dollars tax, as imposed by law, will be required, in U..S. currency, with each application.<br>
 
<p style="font-size: 70%; text-indent: 0;">Five dollars tax, as imposed by law, will be required, in U..S. currency, with each application.<br>
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== Editor's note ==
 
== Editor's note ==
{{Style S-HPB SB. Editors note|Note handwritten at the top:}} <u>pd</u>  {{Style S-HPB SB. Editors note|indicating “paid”}}
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{{Style S-HPB SB. Editors note|Blavatsky's name has been misspelled by Joseph H. Brown as "Blovatsky", it has been corrected in two places, being still wrong in one of them.}}
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{{Style P-No indent|[Note handwritten at the top:]}}
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<u>pd</u>  [indicating “paid”]
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[Blavatsky's last name has been misspelled as "Blovatsky" by the one who filled up the application; it has been corrected in one place, but in another the write spelling has been crossed out and the wrong one written above.]
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{{Style S-HPB SB. Editors note|Written sideways across the application:}}
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[Written sideways across the application:]
    
Court of Common Pleas.
 
Court of Common Pleas.