| Regimental number | 19102 |
| Place of birth | Yarrawonga, Victoria |
| Religion | Church of England |
| Occupation | Police constable |
| Address | Windsor, Victoria |
| Marital status | Married |
| Age at embarkation | 30 |
| Next of kin | Wife, Mrs A Black, 60 Lewisham Road, Windsor, Victoria |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, September 1917 Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A38 Ulysses on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Australian General Hospital |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
