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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

Board oF Conrron Form 5
Institution
em
7 Aca
_ & =
i-t t eee & A
Full Name of IpStitution)
4
Located at Za £ LIA
In the matter of the application of
for the admission
of 2 child to this institution
Number
Application is hereby made for the admission to 7 C4 LA 7 A Z
Full Namg of Institutioyf
of... Z7LC.......child , and in support thereof the following statements are submitted:
(Number
1. Name _of child * Sex. Place and Date of Birth
Family Name (Given Name x
(a) ( / h £7 /
(b)
(c)
(d)
C
Ph. :
2. Status of child Aephan , HaliOrphan Abancoredt
3. Has parent or child any estate, or are they or either of them heir to any estate? If so, deseribe said estate, its location and value, including insurance, if any.
Cea the child ever been legally adopted? If so, by whom?
5. Father’s name Nativity
Place and date of death
6. Mother’s name Nativity
Place and date of death
7. When and where were parents married?
8. Where is marriage certificate recorded?
9. Date father came to California? Mother? To County?
10. Which parent is living? Habits of sobriety?
IL @MeSICeNCG (OF upatent ccs oe ee Occupation?
12. Relation of applicant to child 2
13. Full address of guardian or parent?..2. 4/72
14, the child... inmate of an institution?
15. Name and address of institution?
16. What amount will be given for aid of child..............2 $2472 Caper year. By whom?....
Note 1 1is application may be used for more than ONE child of one family, but not for children of different families.
Note k This application must be recorded in ‘‘Record of Orphans” and forwarded at once to Secretary of Board of Con
Form No. 5-APPLICATION FOR ADMISSION TO INSTITUTION.
A. Carlisle & Co., 8. F
Wah cam Aa Rateen
16. What amount will be given for aid of child..............2 $...2.4..e=.....per year. By whom?.
f, 4 1 fi 2 iT f 2 ily. n r children of different families. is application may be used for more than ONE child of one family, but not for children of di : ; eee
Note 2. This application must be reqorded in “Regord of Orphans” and forwarded at ones to Secretary of Board Of Oontrol, Sacramento, Callfaniia,
Zz
Form No. 5-APPLICATION FOR ADMISSION TO INSTITUTION. A. Carlisle & Co., 8. F.
16. What amount will be given for aid of child/Zz-~..
=
a
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Pd
N
3
5
&
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a
5
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a
Note 1, This application may be used for more than ONE. child of one fai y, but not for child
Note 2. This application must be recorded in “Record of Orphans” and forwarded at once to Secre n of different families.
y of Board of Control, Sacramento, California.
Pi si
eDMISSION TO
‘finn for Admission to
5
ull N Name of Institution) 7
r Ly Le As, al,
) ; ge
ation ot LA UO, “Mihi 0. Af: retal hb for the admission
this institution
n support thereof the following statements are submitted
Sex. Place and Date of Birth
JL). flied! Laantited, fily A Y OP
Zz
Utins wind) O DP
Pes
A
“Orphen , Half Orphan
any estate, or are they or either of them heir to any estate? If so, ded value, including insurance, if any.
r been legally adopted? If so, by whom? Dd: 0.
x V-LAL
Fe E
7 y y;
Nativity Ont
nts married: 2“2-40—.
te recorded?
Habits of sobriety? .
Occupation? ......
? parent ?..
imate of an institution? ......4./
ition?
for aid of child By 7 Sai per year: By whom?...442
than ONE child of one
ecord of Orphans” and f
y, but not for ch: en of different families.
‘ded at once to S etary of Board of Contro! Sacramento, California.
IN TO INSTITUTION. A. Carlisle & Co., 8. F.