| Regimental number | 1395 |
| Place of birth | Balmain New South Wales |
| Religion | Methodist |
| Occupation | Printer |
| Address | La Mascotte Burdett Street, Hornsby, New South Wales |
| Marital status | Single |
| Age at embarkation | 20 |
| Next of kin | Mother, Mrs Ada Matilda Black, La Mascotte Burdett Street, Hornsby, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 17th Battalion, D Company |
| AWM Embarkation Roll number | 23/34/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board Transport A32 Themistocles on |
| Rank from Nominal Roll | Corporal |
| Unit from Nominal Roll | 5th Field Ambulance |
| Recommendations (Medals and Awards) |
Meritorious Service Medal Work at Broodseinde during October 1917. Recommendation date: |
| Fate | Returned to Australia |
| Medals |
Meritorious Service Medal Source: 'Commonwealth Gazette' No. 110 Date: |