| Regimental number | 5119 |
| Place of birth | Singleton New South Wales |
| Religion | Church of England |
| Occupation | Labourer |
| Address | Kurri Kurri, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, Thomas Blackwell, Deakin Street, Kurri Kurri, New South Wales |
| Enlistment date | 13 November 1916 |
| Rank on enlistment | Private |
| Unit name | 30th Battalion, 14th Reinforcement |
| AWM Embarkation Roll number | 23/47/4 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A74 Marathon on 10 May 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 56th Battalion |
| Fate | Returned to Australia 25 January 1919 |
