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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
Sttwated in
Date of Application,
Name in full of child or children.
2
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Place and date of birth.
Z
z Bey gate I a
Father’s and mother’s name.
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o
Where is parents’ marriage certificate recorded?
i-Ft
When did parents come to California?
és (ee ll
Where does living parent reside? (Give town, street and number
Ly
AEA
If father is living give occupation.
Where and when did father die?
8. Where and when did mother die?
Ard Zt) YAS feet
9. Is there any estate or life insurance?
Doe spe? a6 coe
10. What amount will be given for aid to child’s support?
oe
11. Give full address of guardian or parent.
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12. State fully reasons why child is dependent
Ll LABEHLOP LOA ke
All the above is absolutely true, to my best knowledge and beliet.
Sign
1. Only the guardian, officer or parent knowing the facts should sign this application
2. Parent, ¢ , guardian, relatives, should aid in the support of child if possible; living parent
to pay for maintenance of child.
especially the
State Board of Examiners, Form No. 346—APPLICATION FOR ADMISSION TO ORPHAN ASYLUM
‘ather s expected by the State
A. CaRLIsLe & Co., S. F.