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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
Has aid been given heretofore? If so, by whom?... 42 wns t
Who has charge and control of said child 4¢z4-.at present time?...
State fully reasons why child_~4¢<< ..dependent
How long will the child4z¢@¢<remain dependent?
Signature of Applicant. 424 tit Pe o APL LLC OY-4
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Note 1. Only parent, guardian or officer knowing the facts should sign this Repeat JL
Note 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
CERTIFICATE OF APPLICANT
De a ee I I certify that I have made the answers
written after the questions aboyé set forth; that after making said answers, the said questions and
answers were read to me and tien I signed the same; that said answers are true and correct to the best
of my knowledge, information and belief.
Subscribed to this
Applicant.
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