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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 Adnissinn
Orphan Asylum
Situated in
19 foe,,
Name in full of child or children.
(/) Jteartin ftzpe Maaamfetiy
12) fot Led
Oe ee, Och. dal, (M4:
(2/ oS Jthew. Loh... fll,
Place and date of birth.
Father’s and mother’s name.
Where is parents’ marriagé certificate recorded ?
When did parents come to California ?
tL’ CfA t2t, a , '
Where does living parent reside? (Give town, street oe) 1 number.)
Attz of,
If father is living give occupation.
Where and when did ne d Lal Mowafycte
an hits a oa
Where and when did mother die ?
Is there any estate or life insurance ?
20 ,
What amount will be given for aid to child’s support ?
Give full address of guardian or parent.
pe Us a pa OD
2. State fully reasons why childis dependent sees
de exif
All the above is absolutely true, to my best knowledge and belief.
Sign LHL, Lh exreff
Only th rdian, officer or erbeee knowing the facts should sign this application.
Parent, ate, 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. CaruisLe «& Co., 8. F.