| Occupation as written | Housekeeper |
| Standardised occupation | DS01: Domestic service - Indoor service |
| Application received | 19 Nov 1916 |
| Application status | Already a Subject |
| Official | |
| Date of approval or denial | 28 Nov 1916 |
| If rejected, why? | |
| Birthplace as written | Silesia, Germany |
| Modern country | Poland |
| Age on application | 67 |
| Age on arrival in Australia | 9 |
| Port of Departure | Germany |
| Port of Arrival | Sydney |
| Date of arrival | 1 Nov 1858 |
| Name of ship | Amien |
| Voyage | Amien (1858-11-01) |
| Address in Australia | Yandilla Street, Pittsworth |
| Address State | Queensland |
| Time at address | 38 years |
| Previous address 1 | Toowoomba |
| Address State | Queensland |
| Time at address | 20 years |
| Married | Widow | |
| Children | Yes | 5 daughters |
| Name of reference | Daniel McEwan Hunter |
| Occupation of reference | Justice of the Peace, Queensland |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | Pension |
| Other information |