| Occupation as written | House Domestic |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 1 Jan 1905 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 16 Feb 1905 |
| If rejected, why? | |
| Birthplace as written | Warsaw, Poland, Russia |
| Modern country | Poland |
| Age on application | 50 |
| Age on arrival in Australia | 24 |
| Port of Departure | None |
| Port of Arrival | Sydney |
| Date of arrival | 1 Nov 1878 |
| Name of ship | SS Hereford |
| Voyage | Hereford (1878-12-01) |
| Address in Australia | King Street, City Sydney |
| Address State | New South Wales |
| Time at address | 26 years |
| Married | Yes | |
| Children | Yes | 2: one male, one female, living with them at King Street. |
| Name of reference | V.E.Vance |
| Occupation of reference | Justice of the Peace (New South Wales) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |