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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? ur 1 ted. L¢, GLNB. p.
8. Who has ¢ nd control of said child at prébett time? HY Meng f CAAA ed
State fully reasons why child....... dependent “th r...42,. dead, Lhe y iene « Be? plaka
ns satan At dani abled Ae. Wee piece bt chbasis ae
RGF Lhe.
ye
How te will the child remain Jee af eee. pie AX VE
A
Signature of BAA ote hh. UH. ers lal La Be Mes
able , living parent, especially the father, is expected by
CERTIFICATE OF APPLICANT
certify that I have made the answers
Subseribed to this Yuu Gites of See 19:/, Sh
4 ay
Applicant.
Date
Loeation
Recorded this
Admitted
44
Orphan
in Record of Orphans,
’
Ki
Application of
p a
of Institution
for admission 5f
re
oe Se
Ain
MUST BE FILLED OUT BY INSTITUTION.