| Occupation as written | Household Duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 5 Sep 1916 |
| Application status | Approved |
| Official | LTF |
| Date of approval or denial | 12 Oct 1916 |
| If rejected, why? | |
| Birthplace as written | Chester, England |
| Modern country | United Kingdom |
| Age on application | 70 |
| Age on arrival in Australia | 18 |
| Port of Departure | Liverpool |
| Port of Arrival | Melbourne |
| Date of arrival | 15 Jan 1864 |
| Name of ship | Blanchmoor |
| Voyage | Blanchmoor (1864-01-15) |
| Address in Australia | Woodstock |
| Address State | Victoria |
| Time at address | 38 years |
| Previous address 2 | Beechworth |
| Address State | Victoria |
| Time at address | 2 years |
| Previous address 3 | Hawthorn |
| Address State | Victoria |
| Time at address | 6 years |
| Married | Widow | |
| Children | Yes | 3 sons |
| Name of reference | Edward James Box |
| Occupation of reference | Teacher of State School, Victoria |
| Marginalia description | |
| Police report attached | Yes |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |