| Occupation as written | wife |
| Standardised occupation | XX00: Other - Other |
| Application received | 17 Oct 1910 |
| Application status | Approved |
| Official | JAM |
| Date of approval or denial | 18 Oct 1910 |
| If rejected, why? | |
| Birthplace as written | Warsaw, Poland |
| Modern country | Poland |
| Age on application | 62 |
| Age on arrival in Australia | 40 |
| Port of Departure | London |
| Port of Arrival | Sydney |
| Date of arrival | 1 Apr 1887 |
| Name of ship | SS Casko |
| Address in Australia | 300 Drummond Street, Carlton |
| Address State | Victoria |
| Time at address | 21 years, 6 months |
| Previous address 1 | Sydney |
| Address State | New South Wales |
| Time at address | 9 months |
| Married | Yes | |
| Children | Yes | 10: 5 females and 5 males |
| Name of reference | Michael Sheahan |
| Occupation of reference | Justice of the Peace (Victoria) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |