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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:
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Me, dee Orphan Asylum
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Situated in. AZATAHAL . ALLL,
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Date of Application.. Ae Ge: 4,
Name in full of child or children.
Place and date of birth. ,
painesll, LLL, Aloe. 22 BOL.
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Father’s and mother’s name. 4)
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: aYLart CE Cea eee plie >
Where is parents’ marriage certificate recorded?
OZ att tp CMAP Pato
When did parents come to California?
Duly. > LF0/
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ic 4
Where does living parent reside? beg ce street and number.)
If father is living give occupation. se. ; y
Where and when did father die?
Where and when did mother die?
Is there any estate or life insurance? Py, é ;
What amount will be given for aid is child’s support?
Give full address of guardian or parent.
State fully reasons why child ae
Ye ay elle re ee. e L4t3t 4
All the above is absolutely true, to my best knowledge and belief.
Si
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.