| Occupation as written | married woman |
| Standardised occupation | XX00: Other - Other |
| Application received | 23 Apr 1904 |
| Application status | Approved |
| Official | LTF |
| Date of approval or denial | 16 May 1904 |
| If rejected, why? | |
| Birthplace as written | Striegan, Silesia, Germany |
| Modern country | Poland |
| Age on application | 31 |
| Age on arrival in Australia | 20 |
| Port of Departure | Germany |
| Port of Arrival | Adelaide |
| Date of arrival | 11 Dec 1892 |
| Name of ship | SS John Fallern |
| Voyage | John Fallern (1892-12-11) |
| Address in Australia | Burnthill |
| Address State | Western Australia |
| Time at address | 7 years |
| Previous address 1 | Adelaide |
| Address State | South Australia |
| Time at address | 5 years |
| Married | Yes |
| Children | No |
| Name of reference | Mr Cheetham |
| Occupation of reference | Justice of the Peace (Western Australia) |
| Marginalia description | |
| Police report attached | No |
| Link to other applicant | |
| Literate | Yes |
| Reason | N/A |
| Other information |