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Collection: Original Records > Grass Valley Orphan Asylum
Record of Orphans Half-orphans and Abandoned Children (1900-1914 & 1929) (243 pages)
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Page: of 243
Application for Admission
TO
LR LARA re a rig Orphan Asylum
Ziy
Situated in
Date of Application, [ray pe ie 19.2.7
/
Name in full of child or children.
2
Place and date of birth.
ae tis ess 3
Father’s and mother’s name. J
fragt Le 43 Vere, a
Where is parents’ marriage certificate recorded?
ae 2 laf 2) Pe Wea
When did parents come to California?
Where does living parent reside? (Give town, street and number.)
,
P2 Zz EXPY. (2 He SS i ae
If father is living give occupation.
Where and when did father die?
Where and when did mother die?
ee Li
Z g é
Is there any estate or life insurance?
What amount will be given for aid to child’s support?
Give full address of guardian or parent.
Bete a cvs tk Go eens ee a je hee
Teter. frvrre Har . aa A ON a
io Be A eres Ae et
fp PRA AMS £2 LS. Yi a .
All the above is absolutely true, to my best knowledge and belief.
Sign
1. Only the guardian, officer or parent knowing the facts should sign this application. :
2. Parent, estate, lian, relatives, should aid in the support of child if possible: living parent, especially the father, is expected by the
State to pay for maintenance of child
State Board of Examiners, Form No. 346—APPLICATION FOR ADMISSION TO ORPHAN ASYLUM. A. Caruisue & Co., S. F.