| Occupation as written | marrried woman |
| Standardised occupation | XX00: Other - Other |
| Application received | 4 Sep 1911 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 5 Sep 1911 |
| If rejected, why? | |
| Birthplace as written | Dombrofke, Germany |
| Modern country | Poland |
| Age on application | 50 |
| Age on arrival in Australia | 9 |
| Port of Departure | Dombrofke |
| Port of Arrival | Hobart |
| Date of arrival | 22 Sep 1870 |
| Name of ship | S.V. Figara |
| Voyage | Figaro (1870-10-04) |
| Address in Australia | Bismark |
| Address State | Tasmania |
| Time at address | 28 years |
| Previous address 1 | Hobart |
| Address State | Tasmania |
| Time at address | 10 years |
| Married | Yes | |
| Children | Yes | 7: 4 girls and 3 boys, all in Tasmania |
| Name of reference | Clyde Hamilton |
| Occupation of reference | Justice of the Peace (Tasmania) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |