| Regimental number | 4017 |
| Place of birth | Orange New South Wales |
| Religion | Roman Catholic |
| Occupation | Labourer |
| Address | Suntop Vale, Wellington, New South Wales |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Mother, Mrs E Foley, Suntop Vale, Wellington, New South Wales |
| Enlistment date | 24 June 1915 |
| Rank on enlistment | Private |
| Unit name | 2nd Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/19/2 |
| Embarkation details | Unit embarked from Sydney, New South Wales, on board HMAT A7 Medic on 30 December 1915 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 10th Field Ambulance |
| Fate | Returned to Australia 9 March 1919 |
