| Regimental number | 57875 |
| Place of birth | Goondiwindi Queensland |
| Religion | Roman Catholic |
| Occupation | Miner and horse breaker |
| Address | Moorang via Rosewood, Queensland |
| Marital status | Married |
| Age at embarkation | 29 |
| Next of kin | Wife, Mrs M C Lake, Moorang via Rosewood, Queensland |
| Enlistment date | 10 June 1918 |
| Date of enlistment from Nominal Roll | 18 June 1918 |
| Rank on enlistment | Private |
| Unit name | Queensland Reinforcement 5 |
| AWM Embarkation Roll number | 23/111/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A30 Borda on 17 July 1918 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | a Stag Camp |
| Fate | Returned to Australia 1 August 1919 |
