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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
JKO)
ae Le tt Orphan Asylum
Date of Application, 088 a
4,
Situated in
Name in full of child or — ‘
Place and date of birth. es
Father’s and mother’s name.
Where is parents’ marriage certificate recorded ?
When did parents come to California ?
Purdie! Pet. b, [697
Dathe Cl Ue) A TT Ef cea
Where does living pare ar sa (Give town, street and number.)
te c ee
If father is living give occupation.
Where and when did father dig ?
Ue. De a
Where and when did mother die ?
Is there any estate or life insurance ?
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y
a What amount will be given f
es Se 7 ie
Give full address of guardian or pare
2. State fully rez asons why wh dependent
id od child’s support ‘
All the above is absolutely true, to my best knowledge and belief.
Fie
Sign... 4.4.04 Z
1. Only the guardian, officer or parent knowing the facts should sign this ap yplication.
2. Parent, estate, guardia n, relatives, should aid in thé 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., 8. F.