| Occupation as written | Housekeeper for my brother |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 29 Sep 1911 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 2 Oct 1911 |
| If rejected, why? | |
| Birthplace as written | Lindaberg, Nerke, Sweden |
| Modern country | Sweden |
| Age on application | 68 |
| Age on arrival in Australia | 19 |
| Port of Departure | Sweden |
| Port of Arrival | Melbourne |
| Date of arrival | 28 Jan 1862 |
| Name of ship | Dover Castle |
| Voyage | Dover Castle (1862-01-28) |
| Address in Australia | Black Range G. M. Co's, Lease Sandstone |
| Address State | Western Australia |
| Time at address | 6 months |
| Previous address 1 | Ballarat and Melbourne |
| Address State | Victoria |
| Time at address | 49 years |
| Married | No |
| Children | No |
| Name of reference | Thomas Alexander Couper |
| Occupation of reference | Justice of the Peace (Western Australia) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |