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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 How long will the child remain dependent?
Signature of Petitioner
NOTE. State aid is for temporary relief only and must be stopped by the Board of Supervisors and the Board of Control when the necessity
8 under which the application is allowed.
STATE OF CALIFORNIA
ity of
if : solemnly swear or affirm, that I have made
answers written after the questions above set forth; that after making said answers, the said questions
answers were read to me and then I signed the same; that said answers are true and correct to the best
y knowledge, information and belief.
Petitioner.
Subscribed and sworn to before me this
eee (6)
Clerk:
Deputy Clerk.
P:(@)) aereLemces:
NAME ADDRESS
commencing
Orphans Aid
Total allowed $
NAMES
Recorded this_4~ day of
County of
Board of Supervisors
by Board of Supervisors.
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Application of
Amount
per Child
Allowed
per month
ain)