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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
pe) Tele
uid been given heretofore? If so, by whom? ~<Y aAatt
d been five eretorore
Ss dV 10m $5 ri 4
has charge and control of said childaen—.at present time?
fully reasons why child_a¢2« dependent
long will the child remain dependent ?
Signature of Applicant
Only parent, guardian or officer knowing the facts should sign this application
Parent, € a, dian, relatives, should aid in the support of child if possible ving parent, especially the father, i
ay for maintenance of child.
CERTIFICATE OF APPLICANT
certify that I have made the answers
‘ter the questions above set forth; that after making said answers, the said questions and
ere read to me and then I signed the same; that said answers are true and correct to the best
wwledge, information and belief.
‘ibed to this day of
Appleant.
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