| Occupation as written | Domestic |
| Standardised occupation | DS03: Domestic service - Other service |
| Application received | 24 Jun 1910 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 24 Jun 1910 |
| If rejected, why? | |
| Birthplace as written | Gramentz, Germany |
| Modern country | Poland |
| Age on application | 59 |
| Age on arrival in Australia | 19 |
| Port of Departure | Preussen-Germany |
| Port of Arrival | Hobart, Tasmania |
| Date of arrival | 20 Aug 1870 |
| Name of ship | Victoria |
| Voyage | Victoria (1870-08-28) |
| Address in Australia | 213 Campbell Street, Hobart |
| Address State | Tasmania |
| Time at address | 5 years |
| Previous address 1 | Bismark |
| Address State | Tasmania |
| Time at address | 35 years |
| Married | Yes | |
| Children | Yes | 5: 3 boys, 2 girls, all residing in Tasmania |
| Name of reference | RIchard James Lucas |
| 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 |