| Occupation as written | Household Duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 25 Nov 1911 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 29 Nov 1911 |
| If rejected, why? | |
| Birthplace as written | Silesia, Germany |
| Modern country | Poland |
| Age on application | 75 |
| Age on arrival in Australia | 12 |
| Port of Departure | Bremen |
| Port of Arrival | Adelaide |
| Date of arrival | 10 Aug 1848 |
| Name of ship | Leontina |
| Voyage | Leontine (1848-08-01) |
| Address in Australia | Eudunda |
| Address State | South Australia |
| Time at address |
| Married | Widow | |
| Children | Yes | 6: 3 boys and 3 daughters. 2 sons in EUdunda. 'others I do not know'. |
| Name of reference | Tom Nicholls |
| Occupation of reference | Justice of the Peace (South Australia) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |