| Occupation as written | Housewife |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 11 Dec 1912 |
| Application status | Approved |
| Official | GB |
| Date of approval or denial | 19 Dec 1912 |
| If rejected, why? | |
| Birthplace as written | Ritauer, Russia |
| Modern country | Russia |
| Age on application | 59 |
| Age on arrival in Australia | 32 |
| Port of Departure | London |
| Port of Arrival | Brisbane |
| Date of arrival | 24 Oct 1868 |
| Name of ship | Tchebassa |
| Voyage | Chyebassa (1868-10-24) |
| Address in Australia | 92 Robinson Avenue, Perth |
| Address State | Western Australia |
| Time at address | 9 years |
| Previous address 1 | Sydney |
| Address State | New South Wales |
| Time at address | 14 years |
| Previous address 2 | Brisbane |
| Address State | Queensland |
| Time at address | 6 years |
| Married | Yes | |
| Children | Yes | 5: three boys and two girls, all reside in Perth. |
| Name of reference | Albert Charles Twine |
| Occupation of reference | Postmaster, Western Australia |
| Marginalia description | p.1 'female' |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |