| Regimental number | 2014 |
| Place of birth | Bridgeworth Tasmania |
| Religion | Church of England |
| Occupation | Labourer |
| Address | GPO, Kalgoorlie, Western Australia |
| Marital status | Single |
| Age at embarkation | 30 |
| Next of kin | Mother, Mrs Martha Lack, Bridgenorth, Tasmania |
| Enlistment date | 18 February 1915 |
| Rank on enlistment | Private |
| Unit name | 16th Battalion, 5th Reinforcement |
| AWM Embarkation Roll number | 23/33/2 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A20 Hororata on 26 April 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 16th Battalion |
| Fate | Returned to Australia 3 September 1915 |
