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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
LOW UXO YAHLV
VJ NO FONVUASN]
las aid been given heretofore? If so, by whom? DAO» b ET eds
y
Tho has charge and control of said child at present time? A. Lie es.
ate fully reasons why child dependent .Or
4a... (aad. tate A Ta Lj ¢ frp ttf,ow long will the child4¢~©_remain dependent? Ee LD) VI Caat hoot C
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Signature of Applicant oll AA1tte f Pr Maer LJ
1. Only parent, guardian or officer knowing the facts should sign this application
Parent, estate, guardian, relatives, should aid in the support of child if possible, living parent, especially the father, is expected
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0 pay for maintenance of child
CERTIFICATE OF APPLICANT
fi yf md
AY A444.L4 of A244 44 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 correct to the best
mnowledge, information and belief.
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seribed to ae 4 (B ref Lu day of ay ia Ve t 13
Applicant.
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