| Regimental number | 1995 |
| Place of birth | Sebastopol, Victoria |
| Religion | Salvation Army |
| Occupation | Gardener |
| Address | James avenue, Spring Vale, Victoria |
| Marital status | Single |
| Age at embarkation | 22 |
| Next of kin | Father, James Black, James avenue, Spring Vale, Victoria |
| Enlistment date | 12 July 1915 |
| Rank on enlistment | Private |
| Unit name | 4th Light Horse Regiment, 14th Reinforcement |
| AWM Embarkation Roll number | 10/9/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A32 Themistocles on 28 January 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Cyclists Battalion |
| Fate | Returned to Australia 13 February 1917 |
