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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?
Who has charge and control of said childAéee7_at present time?
7
State fully reasons why child dependent
How long will the child remain dependent ?
Signature of Applicant
Note l. O guardian or officer knowing the facts should sign this application
> li Note 2. Paren rd relatives, should aid in the support of child if possible, living parent, especially the father, is expected by
he State to pay for maintenance of child.
CERTIFICATE OF APPLICANT
~
1 gee 9 eg a fe Es his der Paks (WA 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.
Subseribed to this.......... ae ....day of.
a “Applicant.
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