| Name | Vinko Mikacevich |
| Aged | 45 years |
| Occupation | Bottler in Brewery |
| Color | White |
| Complexion | Light |
| Height | 5 feet, 11 inches |
| Weight | 170 pounds |
| Hair | Gray |
| Eyes | Blue |
| Other visible distinctive marks | Scar on Forehead |
| Born | Prckobro (spell?), Austria
Authors note: the city's correct spelling is Preko Brdo and lies just outside of Bjelovar, Croatia |
| on the | 26th day of April, 1870 |
| Current residence | 458 4th Ave. South St. Paul |
| Emigrated to the U.S. from | Liverpool, England |
| On the vessel | Franconia |
| My last foreign residence was | Prckobro, Austria
Authors note: the city's correct spelling is Preko Brdo and lies just outside of Bjelovar, Croatia |
| Renounces allegiance to | Francis Joseph, Emperor of Austria and Apostolic King of Hungary |
| Arrived at the port of | Boston |
| In the State of | Mass. (Massachusetts) |
| On or about the | 10th day of May, 1912 |