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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 Controt Form & Institution / (Full Name/of Institution) Located at In the matter of the application of Ae d is 4 for the admission ‘ child «2 to this institution. (Number Application is hereby made for the admission to.<& ; : (Full Name of/Institution) and in support thereof the following statements are submitted: Number) AGE Name _ of child : Sex. Place and Date of Birth ee ; ; Years . Months Family Name (Given Name) AA, ‘A Status of child/zéaz-....Onphan Se , Bett-Orphan a.. Abandoned Has parent or child, ..any estate, or are they or either of them heir to any estate? If so, de‘ibe said estate, its location and value, including insurance, if any. H_.... the ehildA Father’s name . Chih Ch Mkt Nativity 3/ M4 o Place and date of death Mother’s name Place and date of death.. When and where were parents married ?. Where is marriage certificate recorded? Date father came to California?.#..7 ¢ ...Mother? 7 ’ ‘ Which parent is living?... (Lad dad. i ...Habits of sobriety ? Residence of parent.....4.-6<@000... <M ALLEL. Occupation? Relation of applicant to child Full address of guardian or parent? ‘inmate of an institution? Name and address of institution ?. What amount will be given for aid of child....... ? $ per year. This application may be used for more than ONE child of one family, but not for children of different famili 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., S. F.