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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
Has aid been given heretofore? If so, by whom?
Who has charge and control of said child at present time?
State fully reasons why child dependent
4
How long will the child remain dependent ?
ignature of Applicant
Note 1. Only parent, guardian or officer knowing the facts should sign this application
Note 2. Parent, estate, guardian, relatives, should aid in the support of child if possible, living parent, especially the father, is expected by
State to pay for maintenance of child
CERTIFICATE OF APPLICANT
. peice ts male aac ; : ~ eae certify that I have made the answers
tten after the questions above set forth; that after making said answers, the said questions and
wers were read to me and then I signed the same; that said answers are true and correct to the best
ny knowledge, information and belief
Subscribed to this........ s day of
~ Applicant, s
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