| Regimental number | 13153 |
| Place of birth | Featherstone England |
| Religion | Church of England |
| Occupation | Miner |
| Address | Sandstone, Western Australia |
| Marital status | Married |
| Age at embarkation | 32 |
| Next of kin | Wife, Mrs A Blackburn, 494 Beaufort Street, Perth, Western Australia |
| Enlistment date | 24 January 1916 |
| Rank on enlistment | Private |
| Unit name | Army Medical Corps, Special Reinforcements |
| AWM Embarkation Roll number | 26/99/2 |
| Embarkation details | Unit embarked from Fremantle, Western Australia, on board HMAT A63 Karoola on 14 March 1916 |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 1st Field Ambulance |
| Fate | Returned to Australia 5 July 1919 |
