| Occupation as written | Laundress |
| Standardised occupation | DS01: Domestic service - Indoor service |
| Application received | 15 Apr 1912 |
| Application status | Unknown |
| Official | JAM |
| Date of approval or denial | 15 Apr 1912 |
| If rejected, why? | incomplete. a new form D sent to her but not returned |
| Birthplace as written | Walmisz, Sprossa, Germany |
| Modern country | Poland |
| Age on application | 64 |
| Age on arrival in Australia | 36 |
| Port of Departure | Germany |
| Port of Arrival | Adelaide |
| Date of arrival | 10 Oct 1883 |
| Name of ship | Marsella |
| Voyage | Marsalla (1883-10-10) |
| Address in Australia | Blyth |
| Address State | South Australia |
| Time at address |
| Previous address 1 | Hoyleton |
| Address State | South Australia |
| Time at address |
| Previous address 2 | Manoora |
| Address State | South Australia |
| Time at address |
| Previous address 3 | Blyth |
| Address State | South Australia |
| Time at address |
| Married | Widow | |
| Children | Yes | 4: boys and 2 girls - Laura and Blyth |
| Name of reference | Charles August Ginsler |
| Occupation of reference | Justice of the Peace (South Australia) |
| Marginalia description | p.1 JAM pencilled 'Form D sent on 15/4/12' |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |