| Occupation as written | Married woman |
| Standardised occupation | XX00: Other - Other |
| Application received | 18 Mar 1913 |
| Application status | Already a Subject |
| Official | A.H. |
| Date of approval or denial | 27 Mar 1913 |
| If rejected, why? | |
| Birthplace as written | Posen, Prussia |
| Modern country | Poland |
| Age on application | 57 |
| Age on arrival in Australia | 2 |
| Port of Departure | Germany |
| Port of Arrival | Melbourne |
| Date of arrival | 1 Jan 1858 |
| Name of ship | None |
| Address in Australia | 28 Havelock St, Bendigo |
| Address State | Victoria |
| Time at address | 16 years |
| Previous address 1 | Cornella East |
| Address State | Victoria |
| Time at address | 39 years |
| Married | Yes | |
| Children | Yes | 6: 3 males 3 females of which 3 dead |
| Name of reference | William Cowling |
| Occupation of reference | Justice of the Peace (Victoria) |
| Marginalia description | p.1. 'Pole Female' |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |