page_0002

85
------
1889
[Dunwich?]
COLONIAL SECRETARY'S OFFICE QUEENSLAND
Application for Admission to the Benevolent Asylum, Dunwich.
PLACE [illegible]
DATE February 28 1889
I, THE UNDERSIGNED, hereby apply for admission to the Benevolent Asylum at Dunwich; and, in the event of this Application being approved, I hereby undertake to strictly observe the Regulations and By-laws of the Insititution, and to obey all lawful orders of the Superintendendent or his deputy; and I do hereby declare that the following particulars respecting myself are strictly true :-
1.-Name of Applicant Henry Lentfar rf [illegible] 43
2.-Age 60 w/8 3, 89.
3.-Country where Born Germany
4.-Religion Lutherian
5.-Trade or Calling Tailor
6.-Length of time in Queensland 30 years
7.-Married or Single married
8.-Name, Addresses, and Circumstances of Applicant's Sons or Daughters (if any) none
9.-Names, Addresses, and Circumstances of other Relatives (if any) wife Margaret
10.-Names and Addresses of Employers during the two years immediately preceding the date of this Application, and length of time with each
11.-Particulars of Applicant's Real or Personal Property (if any) none
12.-Particulars of Aid received from Hospitals or other Charitable Institutions during the two years immediately preceding the date of this Application 5 years in
13.-Nature of Chronic Affection (if any) from which Applicant is suffering Paralysis
14.-Reasons for desiring Admission want of means
(Signature of Applicant) Henry Lentfar