| Regimental number | 1889 |
| Religion | Church of England |
| Occupation | Fisherman |
| Address | Fremantle, Western Australia |
| Marital status | Married |
| Age at embarkation | 38 |
| Next of kin | Wife, Mrs Emily Jane Petersen, 171 Sewell Street, East Fremantle, Western Australia |
| Enlistment date | 17 March 1916 |
| Date of enlistment from Nominal Roll | 4 April 1916 |
| Rank on enlistment | Private |
| Unit name | 44th Battalion, 2nd Reinforcement |
| AWM Embarkation Roll number | 23/61/2 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A28 Miltiades on 9 August 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Australian Dermatological Hospital |
| Fate | Returned to Australia 26 September 1917 |
