| Regimental number | 69017 |
| Place of birth | Hawthorn, Victoria |
| Religion | Church of Christ |
| Occupation | Brass moulder |
| Address | 231 Burwood Road, Hawthorn, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, O Carlson, 231 Burwood Road, Hawthorn, Victoria |
| Previous military service | 5th Battalion 22nd Infantry |
| Enlistment date | 31 July 1918 |
| Rank on enlistment | Private |
| Unit name | 16th General (Victorian) Reinforcements |
| AWM Embarkation Roll number | 23/111/3 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board SS Carpentaria on 7 November 1918 |
| Fate | No details of fate entered on Nominal Roll |
