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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
ne TO
Orphan Asylum
Sttuwated in vibegs 74 ; é Aff ,
Name in full of child or children. 5
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all
Place and date of birth. a eee one C ”
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(5 ir y, Z b
Where is parents’ marriage certificate recorded? S
1 1S ES 9
When did parents come to California? eA
GALA.
Where does living parent reside? (Give town, street and number.)
ne an
If father is living give occupation. Shoe f
46 L Wj y ¥
Where and when did father die?
Where and when did mother die? , ?
i
Is there any estate or life insurance?
What amount will be given for aid to child’s support? “7 :
4
Give full address of guardian or parent.
ts
¢ ,
All the above is absolutely true, to my best knowledge and belief.“ Z a g
4 4 /
CCG-ACL£20 » (4242405
rd é FZ .
Sign
1. Only the an, officer or parent knowing the facts should sign this application.
2. Parent, es uardian, 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. Caruiste & Co., S. F’