| Regimental number | 275 |
| Place of birth | Beechworth, Victoria |
| Religion | Presbyterian |
| Occupation | Labourer |
| Address | c/o J W Black, 'Leeton', New South Wales |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Father, J W Black, 1 Veragh Street, Coolamon, New South Wales |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 12th Light Horse Regiment, B Squadron |
| AWM Embarkation Roll number | 10/17/1 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A29 Suevic on |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | 4th Machine Gun Squadron |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
