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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 or Controt Form & Institution Application for Admission to oJ (Full Nyme of Institution) 4 2 ‘f/f Located at In the matter of the application of y Vet ALU : for the admission Of ANI) child AlsAe....t0 this institution. (Number) © 4 Application is hereby made for the admission to..aav2AW.__( allu Oeo VAMAL.{ han. x LAW Z (Full Name of Ingtitution) . yf Efowe _..child/#4.., and in support thereof the following statements are submit ted: (Number) : AGE Name _ of child Sex. Place and Date of Birth “y (Family Name) (Given Name) (a) thu Wad r C ated ; ee td 10, 1402 (+) Ketan, fr : Crd, Miaat.1.b5 a Tip (d) Years . Months (e) 2, « UAUIS, Ol Chil duet Aericn aoe oe Orphen. Half Orphan.... 3. 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, ineluding insurance, if any. LAW Dans Awe ae H.t4A—the child.. ever been legally adopted? If so, by whom? Father’s name... ldemdcag...C CALA.. 3 xi stedaccy DUOUEV IY Place and date of death Saaraag Wnnsrn.a\ Cd. Nae 4 (ba. Te Py J Matis. Mother’s name.. Win ito. OS eC AMAL.. ee eee = Nativity py ee acs on naagnrle,, LV 18 When and where were parents married? (Aan 2 Cam do.. hss oT. sph Where is marriage certificate recorded ?. pe Undaseuas. Place and date of dicate oa eae Date father came to California?.. atu.. Mother? Weltar._To County? Which parent is living? fathee Sete BREN cae Habits of sobriety 24 ro-k eats Residence of parent ue ee ie a3 ...Oceupation? .YY Wy sores A Relation of applicant to child._/ Full address of guardian or parent?.../.0u OL wc Uhh OAA.the childyrvn...inmate of an institution? OVA ie Name and address of institution ?. 16. What amount will be given for aid of child_puse..? $.1G%,.....per year. By whom?..4< 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, Califo; be Form No. 5-APPLICATION FO? ADMISSION TO INSTITUTION. A. Carlisle & Co., S. F.