| Occupation as written | wife |
| Standardised occupation | XX00: Other - Other |
| Application received | 29 Feb 1912 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 13 Mar 1912 |
| If rejected, why? | |
| Birthplace as written | Drehno. Kneis Cotleus, Prussia, Germany |
| Modern country | Poland |
| Age on application | 77 |
| Age on arrival in Australia | 34 |
| Port of Departure | Hamburg |
| Port of Arrival | Port Adelaide |
| Date of arrival | 1 Sep 1868 |
| Name of ship | Caeser Godefroy |
| Voyage | Caesar Godeffroy (1868-09-21) |
| Address in Australia | Yorktown |
| Address State | South Australia |
| Time at address |
| Previous address 1 | Hope Valley |
| Address State | South Australia |
| Time at address | 8 years |
| Married | Yes | |
| Children | Yes | 6: 3 sons and 3 daughters |
| Name of reference | Matthias Ericksen |
| Occupation of reference | Justice of the Peace (South Australia) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |