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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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Boarp oF Controt Form 8 Institution Application for Admission to Located at In the matter of the application of.. ne Le: bir.t-AA2-C—_for the admission Bi * iia] ke Meee ..to this institution. (Number) Application is hereby made for the admission to a fe (Full Name of Institution) _Fve—___ child.. and in support thereof the following statements are submitted: (Number) AGE Name _of child : = Place and Date of Birth S aeee ae : 2 Years . Months (Family Name) (Given Name) * Status of child a irohare: oe ., Half Orphan Has parent or child any estate, or are they or either of them heir to any estate? If so, de"ibe said estate, its location and value, including insurance, if any. ALO Father’s name Place and date of death , Le Mother’s name pie : Place and date of death... When and where were parents married ?... Where is marriage certificate recorded? Date father came to California? ak / 3 ‘QdMother? Mie Which parent is living’?... M Residence of parent 4Z Relation of applicant to child........7. Full address of guardian or parent?.22.¢ the child What amount will be given for aid of child....... ? $ per year. By whom?.//45222% Note 1. This application may be used for more than ONE child of one family, but not for children of different families. P 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., S. F.