| Regimental number | 69288 |
| Place of birth | Oxley New South Wales |
| Religion | Church of England |
| Occupation | Grocer |
| Address | Curlewis Street, Swan Hill, Victoria |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, C E Lacy, Curlewis Street, Swan Hill, Victoria |
| Previous military service | 2nd Battalion 6th Infantry |
| Enlistment date | 10 May 1918 |
| Rank on enlistment | Private |
| Unit name | 17th General (Victorian) Reinforcements |
| AWM Embarkation Roll number | 23/111/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on 2 November 1918 |
| Fate | No details of fate entered on Nominal Roll |
