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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
Has aid been given heretofore? If so, by whom?.../1
Who has charge and control of said child
SUNG
How long
Signature of Applicant..(/./4(/1.-CL&-]
Note 1. Only parent, guardian or officer knowing tk
Note 2. Parent, ate, guardian, ives, should aic
he facts should sign this Bop ation
the State to pay for maintenance of c¢
»ort of child if possible, living parent, especially the father, is expected by
CERTIFICATE OF APPLICANT
iReee YALA vav-s-s-s-----Certify that I have made the answers
written after the questions above set forth; that after making said answers, the said questions and
answers were read to me and then I signed the same; that said answers are true and correct to the best
of my knowledge, information and belief.
Subscribed to this...................26-/../..day of...{J. AY
te
S
+
‘suvydag Jo paoooy
jo uorzeorddy