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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
ANG,
ees VAP, Orphan Asylum
Situated in IB EESOe, billy
Date of Application yoacenttd ie Sa LO eg
Name in full of child or ee ee
Place and date of birth.
CL pedund, Littaded, Palb Jl, B ME,
Father’s and mother’s name.
a
Ga ee f
' La 56S:
Where is parents’ marriage certificate recorded? 2
When did parents come to California?
Vie eke
Where does living parent reside? (Give town, street and number.)
If father is living give occupation. F c
Where and when did father die?
Where and when did mother die?
Is there any estate or life insurance?
What amount will be given for aid to child’s support?
/
Give full address of guardian or parent. é
Led, llaaceratd Me, ye Pe, (23-15 e Jb, hick,
State fully reasons why child is a
All the above is absolutely true, to my best knowledge and belief.
4
Sign Tir. Classical Qi ry, DILL Abd)
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. Caruiste & Co., 8. F’