| Occupation as written | householder. widow |
| Standardised occupation | XX00: Other - Other |
| Application received | 14 Oct 1911 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 19 Oct 1911 |
| If rejected, why? | |
| Birthplace as written | Jena, Germany |
| Modern country | Germany |
| Age on application | 51 |
| Age on arrival in Australia | 49 |
| Port of Departure | Hamburg |
| Port of Arrival | Adelaide |
| Date of arrival | 20 Sep 1909 |
| Name of ship | Roon |
| Voyage | Roon (1909-09-20) |
| Address in Australia | 12 Stafford Street, Adelaide |
| Address State | South Australia |
| Time at address |
| Previous address 1 | 25 Bent Street, Port Adelaide |
| Address State | South Australia |
| Time at address |
| Married | Widow | |
| Children | Yes | 1 girl residing with her |
| Name of reference | G H Lehmann |
| Occupation of reference | Justice of the Peace (South Australia) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |