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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
Application for Admission
Orphan Asulum
Situated in
Date of Application,.....
Name in full of child or children.
Place and date of birth.
Father’s and mother’s name.
Where is parent’s marriage certificate recorded ?
When did parents come to California ?
Where does living parent reside ? (Give town, street and number.)
Where and when did father die ?
When-did-mother die?
Is there any estate or life insurance ?
What amount will be given for aid to child’s support ?
Give full address of guardian or parent:
d.
W
All the above is absolutely true, to my best knowledge and belief.
Sign
1. Only the guardian, Officer or parent knowing the facts should sign this application. t
2. Parent, estate, guardian, relatives, should aid in the support of child if possible; living parent, especially the father, is expected by the
State to pay for maintenance of child.
Form No. 346—APPLICATION FOR ADMISSION TO ORPHAN ASYLUM. A CaRLISLE & Co., 417 Montgomery St., S. F