| Regimental number | 12658 |
| Place of birth | Rhine Villa South Australia |
| Religion | Congregational |
| Occupation | Farmer |
| Address | Rhine Villa, South Australia |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Mother, Mrs Hannah Crefield Payne, Rhine Villa, South Australia |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 11th Field Ambulance |
| AWM Embarkation Roll number | 26/54/1 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A29 Suevic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 11th Field Ambulance |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
