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STATEMENT BY PARENT OR GUARDIAN.

I Hereby Certify, That..

was born in the....

on the....

day of..

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of age; and neither the above official or religious record of birth can
be procured, and that I am the...
of said child.

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who being sworn according to law, deposes and says that the foregoing statement is in every respect true.

Signed...

(Issuing Officer.)

Issuing Officer will detach here and return these Reports to Applicant. One of these blanks must be filled out, and either delivered or mailed to the officer who granted the employment permit each month. If child is unemployed it must attend school.

One of these blanks must be filled out, and either delivered or mailed to the officer who granted the employment permit each month. If child is unemployed it must attend school.

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Employment Permit for Children over 15 and under 16 Years of Age.

Under section 10, Act No. 285 Public Acts 1909 as amended by Act 220 Public Acts 1911, Act 255 Public Acts 1915 and Act 280 Public Acts 1917.

On termination of the employment of the child the employer must forthwith surrender this permit to the child.

A permit is necessary during vacation as well as during school year. Name of Child....

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This is to Certify, That I have this day received and filed all papers required by Sec. 10, Act 285 of the Public Acts 1909, as amended by Act 220 Public Acts 1911, Act 255 Public Acts 1915 and Act 280 Public Acts 1917, and that I have examined the above named child and that....he can read intelligently and write legibly simple sentences in the English language and that....he has reached the normal development of a child of.. ..age, and is in sound health and....he

is physically able to perform the work which....he intends to do, and that the services of the child are essential to the support of itself or parent. I, Therefore, grant hereby to said child permission to be employed.

Signature..

Issuing Official.

FORM No. 49.

Application for Limited Vacation Employment Permit.

For children between 15 and 16 years of age, under Section 10, Act 285, Public Acts of 1909, as amended by Act 220, Public Acts of 1911 and Act 255, Public Acts of 1915, Act 280, Public Acts of 1917.

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I Hereby Certify, That the following is a true transcript of the record of the birth of.

record of

(State from what record taken.)

Place of Birth...

...as shown by the

Date of Birth..

Signed..

(Official Title.)

STATEMENT BY PHYSICIAN OF BOARD OR DEPARTMENT OF HEALTH.

This is to Certify, That I have examined..

and in my opinion....he is fifteen years of age or upwards, is in
sound health and physically able to perform the work....he intends
to do, and that the weight of said child is..
height.

..feet..

.inches. Signed...

.lbs. and

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of age; and neither the above official or religious record of birth can be procured, and that I am the..

.of said child.

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.19...

personally appeared before me,.

who being sworn according to law, deposes and says that the foregoing statement is in every respect true.

Signed...

(Issuing Officer.)

No...

FORM No. 50.

Limited Vacation Employment Permit for Children between 15 and 16 Years of Age.

Under Section 10, Act No. 285, Public Acts 1909, as amended by Act 220, Public Acts 1911; Act 255, Public Acts 1915 and Act 280, Public Acts 1917.

On termination of the employment of the child the employer must forthwith surrender this permit to the child.

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This is to Certify, That I have this day received and filed all papers required by Sec. 10, Act 285 of the Public Acts 1909, as amended by Act 220 Public Acts 1911, Act 255 Public Acts 1915 and Act 280 Public Acts 1917, and that I have examined the above named child and that....he has reached the normal development of a child of.... ..age, and is in sound health and....he is physically able to perform the work which....he intends to do. I, Therefore, grant hereby to said child permission to be employed during the vacation ending MONDAY, SEPTEMBER. .191...., Saturday..........day of .191.

.191...., Holiday...

...day of.

Signature.

Issuing Official.

INDEX.

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