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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
ngges for Admission
TO
Orphan Asylum
Situated in ae, pe
Date of Application, Mets Pat sth i 19/2.
Name in full of child or children.
Picts AC.
pare: or
Place and date of birth.
“ Za. /t, ot £ Se
Father’s and mother’s name.
ee a “
Where is parents’ marriage certificate recorded?
2) tn yes te Gene Cas, hr preeen Sig bie ox ® yp
When did parents come to California?
i ee ee.
Where does living parent reside? (Give town, street and number.)
ae Mid
If father is living give occupation. F
Where and when did father die?
Si, J th uote, Sache hig © £60 an (faassen nigh , ec? sad
Where and when did mother die? ;
{ Uh,
UA LVLA>
Is there any estate or life insurance?
)
What amount will be given for aid to child’s support?
ei -, ¥, ba ; a
NY, Nath aita~ 2? Ge eS a er re é F fr dha fe tack. OLA
Give full address of guardian or parent.
Loch Madd. Dior ry A BH se Aabbspmataadhr Galfrrrd
State fully reasons why onde is dependent LT Biker yz) oo se Bane ¢
ya Ow, thir wd bitte: y Argher ead
All the above is absolutely true, to my best knowledge and belief.
eee eee
1. Only the guardian, officer or parent knowing the facts should sign this ap pi lication
2. Parent, e 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 a: child,
State Board of Examiners, Form No. 346—APPLICATION FOR ADMISSION TO ORPHAN ASYLUM. A. CaruisteE & Co., S. F.