| Occupation as written | no occupation |
| Standardised occupation | XX00: Other - Other |
| Application received | 1 Jan 1911 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 9 Oct 1911 |
| If rejected, why? | |
| Birthplace as written | Krimburgh, Germany |
| Modern country | Germany |
| Age on application | 85 |
| Age on arrival in Australia | 28 |
| Port of Departure | Liverpool |
| Port of Arrival | Melbourne |
| Date of arrival | 1 Jan 1854 |
| Name of ship | Marco Polo |
| Voyage | Marco Polo (1854-01-01) |
| Address in Australia | 22 Stawell Street, Burnley |
| Address State | Victoria |
| Time at address |
| Previous address 1 | Ballarat |
| Address State | Victoria |
| Time at address | 54 years |
| Previous address 2 | Richmond |
| Address State | Victoria |
| Time at address | 3 years |
| Married | Widow | |
| Children | Yes | 1 male |
| Name of reference | John Hume Luke |
| Occupation of reference | Sergeant of Police, Victoria |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | Pension |
| Other information |