| Regimental number | 3004 |
| Place of birth | Beaconsfield England |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Lismore, New South Wales |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Mother, Mrs. Eleanor Keen, West Kyogle, Richmond River, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 2nd Light Horse Regiment, 22nd Reinforcement |
| AWM Embarkation Roll number | 10/7/5 |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT A43 Barunga on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 2nd Light Horse Regiment |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
