| Regimental number | 1504 |
| Place of birth | Port Lincoln South Australia |
| Religion | Church of England |
| Occupation | Station hand |
| Address | Port Lincoln, South Australia |
| Marital status | Single |
| Age at embarkation | 24 |
| Next of kin | Mrs Annie M Owen, Port Lincoln, South Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 10th Battalion, 3rd Reinforcement |
| AWM Embarkation Roll number | 23/27/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A54 Runic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Division Supply Column |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
