| Occupation as written | Domestic duties |
| Standardised occupation | DS00: Domestic service - Domestic duties |
| Application received | 7 Jul 1909 |
| Application status | Approved |
| Official | |
| Date of approval or denial | 29 Jul 1909 |
| If rejected, why? | |
| Birthplace as written | Langenhain, Frankfurt, Germany |
| Modern country | Germany |
| Age on application | 69 |
| Age on arrival in Australia | 17 |
| Port of Departure | Germany |
| Port of Arrival | Melbourne |
| Date of arrival | 27 Jul 1857 |
| Name of ship | Mary Banks |
| Voyage | Mary Banks (1857-07-27) |
| Address in Australia | The Cusent, Talbot |
| Address State | Victoria |
| Time at address | 62 years |
| Married | Widow | |
| Children | Yes | 2: one son (Melbourne) and one daughter (Talbott) |
| Name of reference | John James Henderson Gray |
| Occupation of reference | Police Constable, Talbot, Victoria |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |