| Occupation as written | House duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 17 Mar 1910 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 9 May 1910 |
| If rejected, why? | |
| Birthplace as written | Gablonz, Bohemia, Austria |
| Modern country | Czechia |
| Age on application | 48 |
| Age on arrival in Australia | 15 |
| Port of Departure | Hamburg |
| Port of Arrival | Adelaide, South Australia |
| Date of arrival | 6 Jan 1877 |
| Name of ship | Caesar Godefro |
| Voyage | Caesar Godeffroy (1877-01-06) |
| Address in Australia | Broken Hill |
| Address State | New South Wales |
| Time at address | 22 years |
| Previous address 1 | Adelaide |
| Address State | South Australia |
| Time at address | 11 years |
| Married | Yes | |
| Children | Yes | 2: boy is in South Australia and girl in Broken Hill. |
| Name of reference | William John Ritallick |
| 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 |