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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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BoarpD or Conrrot Form 5 Institution Application for Admission to F ull Nadie of oy ie Located at VU Li Wa i YM. ct LR Ais pe da & 6 ee. ; In the matter of the application of... ma’ MWiakltt A for the admission 1 be sal Oo aap 3 Gs ca to this institution. (Number) Application is hereby made for the admission to” (Full NAme of In titution) -child_..........., and in support thereof the following statements are submitted: AGE Name _ of child STLSt! ET Ans: & Place and Date of Birth Geeanlls Name) Given Name) Status of child... é : , Half Orphan Yt. a Abandoned Has parent or child................any estate, or are they or either of theni heir to any estate? If so, deseribe said estate, its location and value, including insuranee, if any. mas Pg oe ; : LACtAtLe CLS pee eee? the child..............ever been legally adopted? If so, by whom?.... ZO Father’s name Leary. Lt. Nee gases c elf. Nativity Qin VLA MM dee: vs ’ gl runt ytly, Caf, Place and date of « leath.. E ss. 5 ERE. igen ed © ot Mother’s name. , ae i chawedl ae Nativity When and where were parents married ?. ui Where is marriage certificate recorded?.~. Relation of applicant to child........ 4 Full address of guardian or parent » Las, Ny. 1) (/_......the child..... 6. What amount will be given for aid of child.............. ee So ‘a=..per year. By whom?.ZZ 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, California. orm No. 5-APPLICATION FOR ADMISSION TO INSTITUTION. A. Carlisle & Co., S. F.