| Regimental number | 7204 |
| Place of birth | Heywood, Victoria |
| Religion | Roman Catholic |
| Occupation | Cook |
| Address | Ballarat, Victoria |
| Marital status | Single |
| Age at embarkation | 44 |
| Next of kin | Brother, E Black, 94 Lee Street, North Carlton, Victoria |
| Enlistment date | 8 December 1916 |
| Rank on enlistment | Private |
| Unit name | 6th Battalion, 24th Reinforcement |
| AWM Embarkation Roll number | 23/23/6 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A70 Ballarat on 19 February 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 6th Battalion |
| Fate | Returned to Australia 27 August 1917 |
