| Regimental number | 3364 |
| Place of birth | Croydon Queensland |
| Religion | Church of England |
| Occupation | Farmer |
| Address | Burracopin, Western Australia |
| Marital status | Single |
| Age at embarkation | 28 |
| Next of kin | Father, Carl Mouritzen, Lassogade, 25 Copenhagen, Denmark |
| Enlistment date | |
| Rank on enlistment | Private |
| Unit name | 10th Light Horse Regiment, 28th Reinforcement |
| AWM Embarkation Roll number | 10/15/4 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A15 Port Sydney on |
| Rank from Nominal Roll | Driver |
| Unit from Nominal Roll | a Mounted D Train |
| Fate | Returned to Australia |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
