| Regimental number | 4168 |
| Place of birth | Melbourne Victoria |
| Religion | Roman Catholic |
| Occupation | Farmer |
| Marital status | Single |
| Age at embarkation | 23 |
| Next of kin | Mother, Mrs Martha Petersen, Illawarra PO, Illawarra, Victoria |
| Enlistment date | 21 August 1915 |
| Rank on enlistment | Private |
| Unit name | 23rd Battalion, 10th Reinforcement |
| AWM Embarkation Roll number | 23/49/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT A18 Wiltshire on 7 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 57th Battalion |
| Fate | Returned to Australia 8 May 1919 |
