| Regimental number | 4122 |
| Place of birth | Cobargo New South Wales |
| Religion | Church of England |
| Occupation | Bricklayer |
| Address | 79 Carlton Crescent, Summer Hill, Sydney, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs J E Blackman, 79 Carlton Crescent, Summer Hill, Sydney, New South Wales |
| Enlistment date | 13 January 1915 |
| Rank on enlistment | Driver |
| Unit name | Field Artillery Brigade 1, Reinforcement 4 |
| AWM Embarkation Roll number | 13/29/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A8 Argyllshire on 10 April 1915 |
| Rank from Nominal Roll | Gunner |
| Unit from Nominal Roll | 1st Field Artillery Brigade |
| Fate | Returned to Australia 9 March 1919 |
