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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
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[ : 2. Status of child Orphan Half Orphar Abandened—
3. Has parent or child any estate, or are they or either of them heir to any estate? If so, describe said estate, its location and value, including insurance, if any
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4. Haw the childAzm....ever been legally adopted? If so, by whom? F et
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5, Pather’s namie. é C { A, fi Nativity 4 (4/
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Place and date of death.,/Z7< CA Aca AL LIU ZAA BOW MA ACM L.
6. Mother’s name LLet i /, Nativity APM eA
Place and date of death.(2<-¢4
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7. When and where were parents married ?.,.. :
8. Where is marriage certificate recorded? “
9. Date father came to California? 7724¢ a Labe Mother ?...2 alin #To County
0. Which parent is living?....4:4277.7 comes Habits of sobriety? ae os Oct
1. Residence of parent we ba Z. lee ’ e Occupation? A4Zz he
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2. Relation of applicant to child Aw
3. Full address of guardian or parent?.
14. the child ...inmate of an institution? ....4:4Z.0.......... cates tet trae
Dy poNAIMG #00 AG CDR Ot meet NO ee acca ea a ee ce ae
6. What amount will be given for aid of childA4=~...2 $.d.< Lathper year. By whom?...:
Note 1. This application may be used for more than ONE child of one family, but not fo iren of different families. 2
This application must be recorded in “Record of Orphans” and forwarded at once to Secretary of Board of Control, Sacramento, California.
Form No. & —4 PPT 1 eee MISSION TO INSTITUTY” ,