| Occupation as written | Home duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 26 Oct 1909 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 2 Dec 1909 |
| If rejected, why? | |
| Birthplace as written | Boge, Pilsen, Austria |
| Modern country | Czechia |
| Age on application | 56 |
| Age on arrival in Australia | 24 |
| Port of Departure | None |
| Port of Arrival | Adelaide, South Australia |
| Date of arrival | 21 Jan 1878 |
| Name of ship | Herschel |
| Voyage | Herschel (1878-09-15) |
| Address in Australia | 11 Bourke Street, Footscray, Melbourne |
| Address State | Victoria |
| Time at address | 21 years |
| Previous address 1 | Minoia |
| Address State | South Australia |
| Time at address | 10 years |
| Married | Yes | |
| Children | Yes | 5: all girls. |
| Name of reference | H. Gallant |
| Occupation of reference | Justice of the Peace (Victoria) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |