| Regimental number | 1030 |
| Religion | Presbyterian |
| Occupation | Labourer |
| Address | Yangan, via Warwick, Queensland |
| Marital status | Single |
| Age at embarkation | 33 |
| Next of kin | Mother, Mrs. Jorgensen, Yangan, via Warwick, Queensland |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 2nd Light Horse Regiment, 6th Reinforcement |
| AWM Embarkation Roll number | 10/7/2 |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT A7 Medic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Light Horse Regiment |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
