| Occupation as written | Household duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 25 Jun 1909 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 29 Jul 1909 |
| If rejected, why? | |
| Birthplace as written | Strassburg, Lower Rhine, Germany |
| Modern country | Germany |
| Age on application | 53 |
| Age on arrival in Australia | 24 |
| Port of Departure | Baden Baden, Germany |
| Port of Arrival | Melbourne |
| Date of arrival | 5 Apr 1880 |
| Name of ship | Chimborazo |
| Voyage | Chimbarazo (1880-04-05) |
| Address in Australia | Richmond Nr Adelaide |
| Address State | South Australia |
| Time at address |
| Previous address 1 | Lower Light, Long Plain |
| Address State | South Australia |
| Time at address | 23 years |
| Previous address 2 | Ascot Vale, Melbourne |
| Address State | Victoria |
| Time at address | 2 years |
| Married | No |
| Children | No |
| Name of reference | Alfred M. Stapley |
| Occupation of reference | Retired State Teacher, Richmond Nr Adelaide |
| Marginalia description | p.1 'G' |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |