| Regimental number | 3499 |
| Place of birth | Sydney New South Wales |
| Religion | Roman Catholic |
| Occupation | Driver |
| Address | Erskineville, New South Wales |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Mother, Mrs Katherine Black, 31 George Street, Erskineville, New South Wales |
| Enlistment date | 23 November 1916 |
| Rank on enlistment | Private |
| Unit name | 56th Battalion, 9th Reinforcement |
| AWM Embarkation Roll number | 23/73/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A68 Anchises on 24 January 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 36th Battalion |
| Fate | Returned to Australia 10 March 1918 |