Enter a name, company, place or keywords to search across this item. Then click "Search" (or hit Enter).
Collection: Original Records > Grass Valley Orphan Asylum
Record of Orphans Half-orphans and Abandoned Children (1900-1914 & 1929) (243 pages)
Go to the Archive Home
Go to Thumbnail View of this Item
Go to Single Page View of this Item
Download the Page Image
Copy the Page Text to the Clipboard
Don't highlight the search terms on the Image
Show the Page Image
Show the Image Page Text
Reset View and Center Image
Zoom Out
Zoom In
Rotate Left
Rotate Right
Toggle Full Page View
Flip Image Horizontally
More Information About this Image
Get a Citation for Page or Image - Copy to the Clipboard
Go to the Previous Page (or Left Arrow key)
Go to the Next Page (or Right Arrow key)
Page: of 243
Boarb or Conrrot Form 5
Institution
Aympliration for Admission tn
hal Name of Institution)
2, 2
In the matter of the application of hes vs ws MANU for the admission
j child 444 to this institution.
(Nymber
¥
Application is hereby made for the admission to ee Ll, PATE: ce
“(Full Name o : rhitation
Lf child Aé4 and in support thereof the following statements are'Submitted.
(Nuri ber
AGE
Name. of child j F Sex.
Family Name) (Given Name)
Sa ace and Date of Birth (903
LY
\ { : LL / es
() LO a OANA oe Fa
(c) oe Y. Loree. oilo. \fe
(a) ie Lei eed. \etia
(e )
Ad
ae
2. Status of child
3. Has parent or child
scribe said estate, its location and value, including insurance, if any.
Father’s name..(/./4 Ath G fz LATA AMA A 2 A Nativity
Place and:date om destin: is. oe ee :
Mother’s name. AMA
Place and date of death. ath
When and where were parents married aA L
rq
Date Father came to California? tak oem Mother? /(2aAM-ALAL..L0 County, 1]
, {
Which parent is living? LAT Mee anne Habits of scene Ls VY LAL «
i
IPs YP Pap gem
Residence of parent. Lnahe oe. o/ ALA“.. Oceupation? MeLennn. phaser
p
Relation of applicant to wi. adlhe £/X.. BS) Rae ae AR ce ett eater deere serena
the childZé“.<..inmate of an institution ? Liat
Name and address of institution ?: hol. Lec A
What amount will be given for aid of childZ2#.<.? $:200_22.per year. By whom?
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, F-