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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
Boarp or Controt Form &
Institution.
Application for Admission to
(Full Name of JAstitution)
¥ £ Li,
Loeated at CZ, A 4 aA A VG L ee i
In the matter of the application of Dyn) )) , He Nat LE . A Lage, >the admission
'
of 4 REA child A#Ze to this institution
Tae er
\pplication is hereby made for the admission to ple tafe a Wh ste (ALYaA WS Line,
(ial Name of Tumpefation) ~
of AA (_2......childaz22., and in support thereof the following statements are submitted:
(Number)
AGE
Name. of child ‘ Sex. Place and Date of Birth
Years . Months
(Family Name) (Given Name)
0 a AL) M00 Lt gt).. ped les, 9 ofpbe f2lpo4
L#7eele yer ae egy; A ae If 2A Le Now Va oe U7 OF
0 Mgalg ETS Se. (ache FE x aa at Lag 6.—L74.4.
(e) “te og: bie ia fs ¢ rafal CA), pitt *%y
,
2. ‘Status of child.. Orphan : , Half Orphan./¢74.7..Abandoned MAL,
/
3. Has parent or child. any estate, or are they or either of them /neir to any estate? If so, describe said estate, its location and value, including insurance, if any.
Lad. eg AA ORE CCZt407t12t Y
a 2. veo pay ie 2 a fot AOE ALVES OO Fei Sah
A4/ fAALY to? 1
ios the child =. ever been legally adopted? If ¥o, by whom? ae)
$I
of
J
Place and date of set
)
Mother’s name Z 4 : Nativity Lact Md
Place and date of rier 4 é ry Ye, A BL. oa vf bil ( teb. Yay t s. 18d
When and where were parents married ? Ae oe Ss eh Sg Aa. ‘d AAAS..
Where is marriage certificate recorded? Cue CAL. oa 4A ie
fi"
Which parent is living?.... fa U4 ChA?..g Habits of sobriety? wa
L ly je
Residence of parent...(/ Dd a. ”) Shade a7 im (d. Occupation? Vp td. 1 4 cd 12h Ce
tH
Relation of applicant to child A4<tY.? Sa Cy t.t
/
£ y
Full address of guardian or parent? (. LAA. b Vb ak {
the child inmate of an institution ? EO
Name and address of institution? AA f Aas ve
What amount will be given for aid of child Vann 4 fer 4 ies ‘By whom? fA AtA.
Note 1. This application may be used for more than ONE child of one family, but not for children of different families /
Note 2. This application must be recorded in ‘Record of Orphans” and forwarded at once to Secretary of Board of Control, Sacramento, California
Form No. 5—APPLICATION FOR ADMISSION TO INSTITUTION. A. Carlisle & Co., 8. I