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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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? If so, by whom? 7 said child at present time? Ias aid been given heretofore? If so, by whom? Has aid been give etofore? If so, by whom dependent Who has charge and control of said child at present time? State fully reasons why child dependent remain dependent? Signature of Petitioner up and m b a th ard o upervisors and the ar ner e ‘essity just be stopped by the Board of Si pervisors and the Board of Control when the nec ssity How long will the child remain dependent? Signature of Applicant 2 ae aE fT Sa dee especially the father, is expected by solemnly swear or affirm that I have mad ons above s th: pe = é ‘ i exe ibove set forth: that after making said answers, the said question n I signed the same; sai Swers are tru Tr st g same; that said answers a Sé ‘ s é a 3 oe true and cor ect to the bes guardian or officer knowing the facts should sign this application Note 1. Only parent , : the State to pay for maintenance of child CERTIFICATE OF APPLICANT Petitioner. 2 me this 19 if 5 bAAstIAA—... 4) 2 Chr. jiZ certify that I have made the answers written after the questions above set forth; that after making said answers, the said questions and Clerk. answers were read to me and then I signed the same; that said answers are true and correct to the best 2 of my knowledge, information and belief. Deputy Clerk. ADDRESS Subscribed to this.. day of a a te Ate Ap. de Applicant. Il $ pemoyye [rjoy, LLVLS Ply suvqdig » C proooy 11g) ¢ ‘ON ijt jo Ajunog a Un S.OSIGVAIINGS JO Qavogy é jo uorjeorddy INYOXTIVO AO JO UOISSI UE