| Occupation as written | Housewife |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 2 Jun 1915 |
| Application status | Already a Subject |
| Official | |
| Date of approval or denial | 23 Jul 1915 |
| If rejected, why? | |
| Birthplace as written | Carlirs, Russian Poland |
| Modern country | Poland |
| Age on application | 40 |
| Age on arrival in Australia | 26 |
| Port of Departure | London |
| Port of Arrival | Fremantle |
| Date of arrival | 1 Jun 1900 |
| Name of ship | Gera |
| Voyage | Glera (1900-06-01) |
| Address in Australia | 119 Lincoln Street, Perth |
| Address State | Western Australia |
| Time at address | 13 years |
| Previous address 1 | Broome |
| Address State | Western Australia |
| Time at address | 7 years |
| Previous address 2 | Cottesloe |
| Address State | Western Australia |
| Time at address | 6 years |
| Married | Yes | |
| Children | Yes | 1 daughter |
| Name of reference | Arthur William Bessgman |
| Occupation of reference | Justice of the Peace, Westerrn Australia |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |