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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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Has aid been given heretofore? If so, by whom? A 4 Le JZ, 17. Has aid been given heretofore? If so, by whom? 1 f, pS ANE ME! IZ Zz te ae see 2 Zr, eg 18. Who has charge and control of said child. =.al: PE po : 18. Who has charge and control of said child 4d44#(At present ‘time? are LLL LAL 19. State fully reasons why child/-4at-.444~.dependent .4 : 19. State fully reasons why child.A~44 dependent Ws a fe ee 4 PIED a ntane/ V,, . iy A cal odie 20. How long will the child remain dependent? 20. How long will the child4c4<~_.remain dependent ? A Laban MMi het eta itis Signature of Applicant (ZZ VA WZ, y Me S A , Signature of Applicant Lhe Ld, é LAAEL a LE. G LLL Note 1. Only parent, guardian or officer knowing the facts should sign this a of Note 2. Parent, estate, guardian, relatives, should aid in the support of chi the State to pay for maintenance of child n or officer knowing the facts should relatives, should aid in the sur upplicatior ild if possible, living parent, especially the father, is expected by CERTIFICATE OF AF CERTIFICATE OF APPLICANT written after the iagions hee sof : hath, that after m eo ; ..~..certify that I have made the answers answers were read o me and then I signed the same; that written after the questions above set forth; that after making said answers, the said questions and of my knowledge, information and belief. answers were read to me and then I signed the same; that said answers are true and correct to the best of my knowledge, information and belief 7 Subscribed to this. OQ AME day of.. LEA y ese ¢ ‘ +} : 7 * y VA Subscribed to this A day of 5 og y, / / / A ) Applicant. = NOS Bee ee : BY <q ee SK eee by Ps \ i ‘ idee 5 = i \ w 5 ey \ iy ‘ \\ ro. ee, S) o 3} t a i © ? ro) 2 D o 3 eee 5 es) t+ =a S \ tata a } ae wa o . a & “ \ } : cee z = Q: \ a \ Ss ~ ° oe . a au 5 \ . B ie a o . hy ° —_ NS : i ~ a ® . s bh . 4 So be . 7 t * iy ~ as s { \ = : se Ss 8 ; 2 = . Y : iS) . 5 Ei cuales ° ie Spee RRS ET V3 ‘ Zz — . q © =e % ha o & \ =) 5 ees = wl s = as * Jog 4 > oy aE Bit’ Gy ~ i 7) = ° + < o iN 5 Be 2 oO r rk x oO ‘ 4 ~ a IQ Fe oNX : a t . ® : \ : je { \ q 5 H ’ pee 7) 4 : : i Z . ES .