| Occupation as written | Home duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 23 Aug 1912 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 26 Aug 1912 |
| If rejected, why? | |
| Birthplace as written | Heckel, Posen, Germany |
| Modern country | Poland |
| Age on application | 69 |
| Age on arrival in Australia | 10 |
| Port of Departure | Germany |
| Port of Arrival | Port Adelaide |
| Date of arrival | 28 Dec 1855 |
| Name of ship | Steinwart |
| Voyage | Steinwärder (1855-12-28) |
| Address in Australia | Wodonga |
| Address State | Victoria |
| Time at address | 41 years |
| Previous address 1 | Landock Valley |
| Address State | New South Wales |
| Time at address | 3 years |
| Previous address 2 | Bloomberg |
| Address State | New South Wales |
| Time at address | 6 years |
| Previous address 3 | Mount Gambier |
| Address State | South Australia |
| Time at address | 9 years |
| Married | Yes | |
| Children | Yes | 7: 4 male and 3 female. (1 dead) |
| Name of reference | Abraham Lincoln Wright |
| Occupation of reference | Justice of the Peace (Victoria) |
| Marginalia description | p.1 nationality 'German' is crossed out and 'Pole' written |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |