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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 5& Institution Located at In the matter of the application of : hile. se" to this institution. (Number Application is hereby made for the admission to <7“<22@&__.1 a fa f (Full Name ofAnstitutioy child.. and in support thereof the following statements afé submitted: (Number) AGE Name _of child Sex. Place and Date of Birth (Family Name (Given Name) Regra . Sony e ae Status of child ., Half Orphan Has parent or child........any estate, or are they or either of them heir to any estate? If so, describe said estate, its location and value, including insurance, if any. He re child ..ever been legally adopted? If so, by whom? ; / } /. Place and date of death 6. Mother’s name../ Place and date of death When and where were parents married? 8. Where is marriage certificate recorded? /Cc ae9. Date father came to California? 7d. 7.d~ -Mother?.. f ey Poy County?A 10. Which parent is living?.4.A44.-0.£E03 é ..-Habits of sobriety? C7’ 11. Residence of parentALA4¢-LEF CA.. A (bah nae Occupation ? 12. Relation of applicant to child Full address of guardian or parent?. 1 ee the Childe: inmate of an institution? 15. Name and address of institution? 16. What amount will be given for aid of ehild....... ? §$ per year. Note 1. This application may b 1 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., 8. F.