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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
Boarp or Conrrot Forum 5
Institution
Application for Admission tn
(Full Namé of Institution)
Located at
In the matter of the application of... FAC: é LT EY for the admission
/
ehildc «to this institution.
(Number
Application is hereby made for the admission to.....64% CL LMA heh thf... —
Full Name of Institution
: child. 424, and in support thereof the following statements are submitted:
(Number)
: AGE ae
Name. of child a Sex. Place and Date of Birth
. A Years Months
Family Name Given Name) os
i 4 ;
Status of childAcn : Orphan ace. , Beleorphan Abaaorred
Has parent or child stAme....any estate, or are they or either of them heir to any estate? If so,
seribe said estate, its location and value, including insurance, if any.
H the child ever been legally adopted? If so, by whom?
Father’s name.....2Z [LAA GAM Mh laeelAaie Nativity 4.2
Place ana uate of death
Mother’s name....A7ACL.._ ee LAL Nativity
VA
Place and daté of death..... f Yo [it Bt EOC; te
i) : ,
/
When and where were parents married? VA
Where is marriage certificate recorded?
Date father came to California? ....Mother ? To County?
7 atl
t1t tte Which parent is living? Habits of ‘sobriety ?
7 af
.
a
A),
“A
.
Residence of parent
7 AAO LLAT. CL
Occupation?
ye
Relation of applicant to child
Full address of guardian or parent?
the childAt4+4—.inmate of an institution?
Name and address of institution ?
What amount will be given for aid of child ? $ per year. By whom?
Note 1. ‘This application may be used for more than ONE child of one family, but not for children of different families
Note 2. This application must be recorded in ‘Record of Orphans” and forwarded at once to Secretary of Board of Control, Sacramento, California
Form No. 5—APPLICATION FOR ADMISSION TO INSTITUTION. A. Carlisle & Co., 5. I