| Regimental number | 2255 |
| Place of birth | Gymbowen, Victoria |
| Occupation | Labourer |
| Address | Wallacedale, Victoria |
| Marital status | Single |
| Age at embarkation | 27 |
| Next of kin | Father, Robert Black, Wallacedale, Victoria |
| Enlistment date | 20 July 1915 |
| Rank on enlistment | Private |
| Unit name | 22nd Battalion, 4th Reinforcement |
| AWM Embarkation Roll number | 23/39/2 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A20 Hororata on 27 September 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 22nd Battalion |
| Fate | Returned to Australia 8 April 1919 |
