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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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BoarpD or Controt Form & Institution Application for Admission tu eed Ai ee eet de (Full Name ofAnstitution) Located at... In the matter of the application of A (aL ERA AA AA for the admission LZ. child. to this institution. (Number) Application is hereby made for the admission to... LA. MA CL = (Full Name of Anstitution) load child............, and in support thereof the following statements are submitted: (Number) AGE = Sex lace ¢ Yate f Birtl ama pers a oCLG Place and Date of Birth Name _ of child (Family Name) (Given Name) Bee eUAUUS Ol shih es si eres inn ed SOrphiin sis , Half Orphan.................... Abandoned. 3. Has parent or child... _any estate, or are they or either of them heir to any estate? If so, describe said estate, its location and value, including insurance, if any. / (2 eee ve child ? LL. Father’s name Place and date 6. Mother’s name.s2<4:041A Ath the... Se Mah 7.. Nativity Place and date of death... /24(4Z..,...../ ike Barf POY, 4 i} When and where were parents married? A< ) 8. Where is marriage certificate recorded 44 ; D 9. Date father came to California? LE ee Mother? ClAMiA® To County? Va Cae b 10. Which parent is living? Sf. La th ah eae : Habits of sobriety?Residence of parent A¢_CALLZL9 bel ae Occupation? Relation of applicant to child................ Full address of guardian or parent? the child...............nmate of an institution? Name and address of institution ?.. 16. What amount will be given for aid of child..............2 $ per year. By whom!?...< This application may be used for more than ONE child of one family, but not for children of different families. 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., 8S. F.