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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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Application for Admission TO Gas ee, ae aeareaen Orphan Asylum oe / Date of Application, << 26 ol fae, é Name in full of child or children. Y Place and date of birth. ‘Ooo La ie i G an Father’s and mother’s name. zal ae Where is parents’ ares certificate recorded? Foran 0 W yi did 1s ents sme to California? Where does living parent reside? ae town, street and nambee. , Qupads Dau, Cals laautae (M1. oe fathef is living give de cain Where and when did father die? eae oe VA Where and when did mother die? / Is there any estate or life insurance? 7lo What pale will be given for aid to child’s support? ae full address of eg an or parent. State fully reasons why child is dependent oan 0 XAr poets exper a nae Lh2t02.. All the above is absolutely true, to my best knowledge and belief. 1. Only the guardian, officer or parent knowing the facts should sign this application. i 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. State Board of Examiners, Form No. 346—APPLICATION FOR ADMISSION TO ORPHAN ASYLUM. A. CanusLe & Co., 8. F.