| Occupation as written | None |
| Standardised occupation | XX00: Other - Other |
| Application received | 1 Jan 1909 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 9 Sep 1909 |
| If rejected, why? | |
| Birthplace as written | Nieshawa, Poland |
| Modern country | Poland |
| Age on application | 69 |
| Age on arrival in Australia | 41 |
| Port of Departure | Thorn, Poland |
| Port of Arrival | Sydney |
| Date of arrival | 1 Jan 1881 |
| Name of ship | Kathania |
| Voyage | Kathania (1881-01-01) |
| Address in Australia | 32 Arthur Street, Sydney |
| Address State | New South Wales |
| Time at address | 4 years |
| Previous address 1 | Hay |
| Address State | New South Wales |
| Time at address | 7 years |
| Previous address 2 | Goulburn |
| Address State | New South Wales |
| Time at address | 17 years |
| Married | Widow | |
| Children | Yes | 6: Four male and two female |
| Name of reference | Margaret Mandelson |
| Occupation of reference | Public School Teacher, Sydney, New South Wales |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |