| Occupation as written | Widow of no occupation |
| Standardised occupation | XX00: Other - Other |
| Application received | 27 Nov 1916 |
| Application status | Approved |
| Official | LTF |
| Date of approval or denial | 4 Jan 1917 |
| If rejected, why? | |
| Birthplace as written | Lodz, Russia-Poland |
| Modern country | Poland |
| Age on application | 66 |
| Age on arrival in Australia | 41 |
| Port of Departure | England |
| Port of Arrival | Melbourne |
| Date of arrival | 18 Dec 1891 |
| Name of ship | Kaiser Wilhelm |
| Voyage | Kaiser Whilhelm I (1891-12-18) |
| Address in Australia | 304 Drummong Street, Carlton |
| Address State | Victoria |
| Time at address |
| Previous address 1 | Melbourne |
| Address State | Victoria |
| Time at address |
| Married | Widow | |
| Children | Yes | 1 son |
| Name of reference | Barnett Hyman Altson |
| Occupation of reference | Justice of the Peace (Victoria) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |