| Occupation as written | Domestic duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 17 Oct 1909 |
| Application status | Unknown |
| Official | |
| Date of approval or denial | 20 Oct 1909 |
| If rejected, why? | incomplete - missing Form D |
| Birthplace as written | Nienhagen, Germany |
| Modern country | Germany |
| Age on application | 74 |
| Age on arrival in Australia | 29 |
| Port of Departure | Germany |
| Port of Arrival | Adelaide |
| Date of arrival | 30 Nov 1864 |
| Name of ship | Susanna |
| Voyage | Susannah (1864-11-30) |
| Address in Australia | Terowie |
| Address State | South Australia |
| Time at address | 2 years |
| Previous address 1 | Waterloo |
| Address State | New South Wales |
| Time at address | 35 years |
| Previous address 2 | Stulton |
| Address State | |
| Time at address | 8 years |
| Married | Yes | |
| Children | Yes | 3: two sons and one daughter. Their daughter is married and lives in Terowi. One son lives in Waterloo and the other in Gumbowie. |
| Name of reference | Henry Richards |
| Occupation of reference | Justice of the Peace (South Australia) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |