Name: Molineaux, Doris W Age:22
Sex: Female
Present Occupation: Teacher
Intended Occupation: Stenographer
Birthplace: Tarleton, Nr Preston
Race or People: English
Citizenship: British
Religion: Church of England
Object in going to Canada: To join brother and uncle
Do you intend to remain permanently in Canada? Yes
Have you ever lived in Canada: No
Money in possession belonging to passenger: 5 pounds
Can you read? Yes
What language? English
By whom was your passage paid? Me
Ever refused entry to or deported from Canada? No
Destined to: Mr Barr (uncle), P.O. Box 13, Sudbury, Ontario
Nearest relative in country from which you came? William Hinde, uncle, Hesketh Lane, Tarleton, Nr Preston
Are you or any of your family mentally defective? No
Tubercular? No
Physically defective? No
Otherwise debarred under Canadian immigration law? No
Signature: [D W Molineux]