| Occupation as written | domestic duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 20 Feb 1911 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 24 Feb 1911 |
| If rejected, why? | |
| Birthplace as written | Valm, Pommerania, Germany |
| Modern country | Poland |
| Age on application | 55 |
| Age on arrival in Australia | 28 |
| Port of Departure | Germany |
| Port of Arrival | Maryborough |
| Date of arrival | 1 Jun 1883 |
| Name of ship | Sebastian |
| Voyage | Sebastian (1883-06-01) |
| Address in Australia | Adelaide Lane |
| Address State | Queensland |
| Time at address | 14 years |
| Previous address 1 | Adelaide |
| Address State | South Australia |
| Time at address | 14 years |
| Married | No |
| Children | No |
| Name of reference | John Ernest Miller |
| Occupation of reference | Justice of the Peace (Queensland) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |