| Occupation as written | married woman |
| Standardised occupation | XX00: Other - Other |
| Application received | 9 Oct 1911 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 12 Oct 1911 |
| If rejected, why? | |
| Birthplace as written | Samitz bei Haynau, Schlesien, Prussia |
| Modern country | Poland |
| Age on application | 66 |
| Age on arrival in Australia | 30 |
| Port of Departure | Germany |
| Port of Arrival | Melbourne |
| Date of arrival | 12 Jan 1875 |
| Name of ship | Sommersetshire |
| Voyage | Somersetshire (1875-01-22) |
| Address in Australia | Hochkirch |
| Address State | Victoria |
| Time at address | 35 years |
| Previous address 1 | Hill Plain, Bonalla |
| Address State | Victoria |
| Time at address | 9 months |
| Previous address 2 | Penshurst |
| Address State | New South Wales |
| Time at address | 8 months |
| Married | Yes | |
| Children | Yes | 4: females residing in same town |
| Name of reference | Phillip O. Miller |
| Occupation of reference | Postmaster, Victoria |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |