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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
aid been given heretofore? If so, by whom? oe Sone In
has charge and control of said child€#a. at present es
» fully reasons why child. Adan art de pendent . Halll ii “Sa
, long will the child remain dependent? . Cay. hot ~ a
Signature of Applicant
Only parent, guardian or officer knowing the facts should sign this eopi ation.
Parent, € ®, guardian, relatives, should aid in the support of child if possible, living parent, especially the father, is expected by
pay for maintenance of child.
CERTIFICATE OF APPLICANT
Cree P27 co 22k certify that I have made the answers
after the questions above set forth; that after making said answers, the said questions and
were read to me and then I signed the same; that said answers are true and eorrect to the best
nowledge, information and belief.
seribed to this2z ay of..
Applicant.
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