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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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Boarp or Conrrot Form 5 Institution Application for Admission to (Full Name Pacis ution) A. Located at oo Atte VA In the matter of the application of eee AMY... f..dAfeP for the admission é aA child..2.4*~....to this institution. (Number) (Full Ndme of InstifAtion Application is hereby made for the admission to g ede £ f OL shild 4.44, and in support thereof the following statements are submitted: AGE Name. of child Sex. Place and Date of Birth > ¥ , Years Months (Family Name) Given Name) f Bilt Status of child Ac44. Caer: ....., Half Orphan Has parent or child«cé14....any estate, or are they or either of them heir to any estate? If so, deseribe said estate, its location and value, including insurance, if any. Hazy..the child4.2.....ever been legally Father’s name Place and date of death 6. Mother’s name... LAL Place and date of death When and where were parents married ?_A. Where is marriage certificate recorded? J Date father came to California? VALE vs of yy Which parent is living?....7.247 EOELL... : . Habits of sobriety ? . Mother?...4¢¢@#é2“€2..To County? .~ Residence of parent.o< 2 ; (LAP kag. AML Y Occupation? Relation of applicant to childaexm....? Full address of guardian or parent?......... the child.4ac.....1nmate of an institution? Name and address of institution? 6. (aA sD ee hc. per year. By whom?.<7& LMM... an ONE child of one family, but not for children of different fami ord 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. F.