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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
TO
att! U ahs Ley
Orphan Asylum
Situated in ZF ZtZet s athts
Date of Application,
ik ‘
Name in full of child or children. Ela Angela nes ted
2° Josephine Anlomn
a, Cam Dts Rarthrliney i
ay Uw vio v
SP : A.
Place and date of birth. Parnn 8 4 Crnnas ae aprt (S5 (Vo 2 / aa
2, “ PSO Gs Xe
a) , Sy @ IJos
sees ale (Fo
J. Calf, dug & 1909
Father’s and mother’s name.
Framcesca Cou
Where is parents’ marriage certificate recorded?
Now Castle . (Fr
Nerv 140.7
When did parents come to California?
Where does living parent reside? (Give town, street and number.)
Reddeng Car
If father is living give occupation.
Whats and when cia fete tee ales, fol Nov . 140A
Where and when did mother die?
Is there any estate or life insurance? no
What amount will be given for aid to child’s support?
Give full address of guardian or parent. ;
12. State fully reasons why child is dependent Mother. Canuefene ee Oe
x (
and Care hey age as ee
All the above is absolutely true, to my best knowledge and belief.
Sign Ney,
1. Only the guardian, officer or parent knowing the facts should sign this application
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. CARLISLE & Co., S. F.