| Occupation as written | Second Hand Dealer |
| Standardised occupation | DE12: Dealing - General dealers |
| Application received | 12 May 1904 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 20 Jun 1904 |
| If rejected, why? | |
| Birthplace as written | Bialystock, Poland, Russia |
| Modern country | Poland |
| Age on application | 42 |
| Age on arrival in Australia | 28 |
| Port of Departure | Bremen |
| Port of Arrival | Melbourne |
| Date of arrival | 15 May 1890 |
| Name of ship | G.M.S. Hapsburg |
| Voyage | Hapsburg (1890-05-15) |
| Address in Australia | 34 Sussex Street, Sydney |
| Address State | New South Wales |
| Time at address | 8 years |
| Previous address 1 | Carlton and Richmond, Melbourne |
| Address State | Victoria |
| Time at address | 6 years |
| Married | Widow | |
| Children | Yes | 4: three boys and one girl residing with her |
| Name of reference | Charles Hubert Foley |
| Occupation of reference | Justice of the Peace (New South Wales) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |