| Regimental number | 4055 |
| Place of birth | Gateshead England |
| Religion | Methodist |
| Occupation | Carpenter |
| Address | 'Saltwell', Kenwyn Street, Hurstville, New South Wales |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, John Black, 'Saltwell', Kenwyn Street, Hurstville, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 1st Pioneer Battalion, 11th Reinforcement |
| AWM Embarkation Roll number | 14/13/5 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A72 Beltana on |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
