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Collection: Original Records > Grass Valley Orphan Asylum

Department of Social Welfare - Annual Reports (1928-1935) (190 pages)

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FAMILY HISTORY---Continued RELATIVES Sisters Brothers Interested Relatives....]---------------------NAME AGE ADDRESS The preceding statements are true to best of my kno wledge and I also promise to take back said child in case the & Wassermann Blood Test proves Positive or Suspicious. Addtional Information: Signature of Agent Receiving Child.