| Regimental number | 4754 |
| Place of birth | Austinville New South Wales |
| Religion | Church of England |
| Occupation | Carter |
| Address | Lismore, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs A A Black, Booyong, New South Wales |
| Enlistment date | 25 July 1915 |
| Rank on enlistment | Private |
| Unit name | 15th Battalion, 15th Reinforcement |
| AWM Embarkation Roll number | 23/32/2 |
| Embarkation details | Unit embarked from Brisbane, Queensland, on board HMAT A73 Commonwealth on 28 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 15th Battalion |
| Fate | Returned to Australia 23 May 1917 |
