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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
Orphan Asylum
Situated in a 4A tht. “Le at. is
Yh
Date of Application, L/
Name in full of child or children.
C1 MBALL. Het he i Le ee ele
ace Sacen date of birth.
3. Father’s and mother’s name.
Where is parents’ marriage certificate recorded?
5 :
OANA i a th tO... L Lif AA AML...
When did parents pag to California?
Z
&
Where does living parent reside? (Give town, street and number.)
SF tac Ge Aha Bn ih He
If father is living give occupation.
Where and when did father die?
Where and when did mother die?
a
Li beta a
Is there anf estate or life insurance?
What amount will be given for aid to child’s support?
11. Give full address of guardian or parent. y,
12. State fully reasons why child is dependent hen a CLO TALIM.
we
Were Fee eg Ae
Z
C cart
All the above is absolutely true, to my best knowledge and belief.
Sign oe Mea
1. Only the guardian, officer or pa knowing the facts should sign this application.
2. Parent, estate, guardian, relativ hould 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’