| Occupation as written | widow of no occupation |
| Standardised occupation | XX00: Other - Other |
| Application received | 1 Jan 1917 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 7 Feb 1917 |
| If rejected, why? | |
| Birthplace as written | Bendigo, Victoria |
| Modern country | Australia |
| Age on application | 54 |
| Age on arrival in Australia | None |
| Port of Departure | None |
| Port of Arrival | None |
| Date of arrival | None |
| Name of ship | None |
| Address in Australia | 5 Royal Place, Richmond |
| Address State | Victoria |
| Time at address |
| Married | Widow | |
| Children | Yes | 1: male born in Victoria |
| Name of reference | John Digby |
| Occupation of reference | Justice of the Peace, Victoria |
| Marginalia description | By birth nationality on application, written 'German' but crossed out 'not nated. French' |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information | renaturalisation |
Application under arrival information: 'in the year 1890 I was married to George Wiard de Vries a German subject of French descent at St Patricks Cathedral Melbourne in the state of Victoria'
Approved by Executive Council on 7 February 1917.