| Regimental number | 4104 |
| Place of birth | Drayton Queensland |
| Religion | Presbyterian |
| Occupation | Assistant Superintendent Aboriginal Settlement |
| Address | Barrambah Aboriginal Settlement, Murgon, Queensland |
| Marital status | Married |
| Age at embarkation | 33 |
| Next of kin | Wife, Mrs Marion Petersen, Cotton Street, Sandgate, Queensland |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 4th Pioneer Battalion, Reinforcement 11 |
| AWM Embarkation Roll number | 14/16/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 4th Pioneer Battalion |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
