| Regimental number | 4121 |
| Place of birth | Townsville Queensland |
| Religion | Salvation Army |
| Occupation | Railway employee |
| Address | Mullumbimby, New South Wales |
| Marital status | Single |
| Age at embarkation | 33 |
| Next of kin | Mother, Mrs Rose Ann Stapleton, Mullumbimby, North Coast, New South Wales |
| Enlistment date | 2 June 1917 |
| 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 1 August 1917 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | Australian Army Medical Corps Details |
| Fate | Returned to Australia 9 August 1919 |
