| Occupation as written | Married woman |
| Standardised occupation | XX00: Other - Other |
| Application received | None |
| Application status | Approved |
| Official | |
| Date of approval or denial | 28 Sep 1904 |
| Birthplace as written | Warsaw |
| Modern country | Poland |
| Age on application | 41 |
| Age on arrival in Australia | 19 |
| Port of Departure | London |
| Port of Arrival | Brisbane |
| Date of arrival | 20 Jan 1884 |
| Name of ship | Linlithgowshire |
| Address in Australia | 122 Sussex Street, Sydney |
| Address State | New South Wales |
| Time at address | 19 years, 3 months |
| Previous address 1 | Brisbane |
| Address State | Queensland |
| Time at address | -1 years, 9 months |
| Married | Yes | |
| Children | Yes | Five children - one girl and four boys (one boy is in South Africa). |
| Name of reference | Peter Mc Lachlan |
| Occupation of reference | J.P. |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | No |
| Reason | N/A |
| Other information |