| Regimental number | 4058 |
| Place of birth | Sale Victoria |
| Religion | Roman Catholic |
| Occupation | Butcher |
| Address | 518 Lorne Street, Moonee Ponds, Victoria |
| Marital status | Single |
| Age at embarkation | 18 |
| Next of kin | Father, Mr Smith, 518 Lorrie Street, Moone Ponds, Victoria |
| Enlistment date | |
| Date of enlistment from Nominal Roll | |
| Rank on enlistment | Private |
| Unit name | 12th Battalion, 12th Reinforcement |
| AWM Embarkation Roll number | 23/29/3 |
| Embarkation details | Unit embarked from Melbourne, Victoria, on board HMAT RMS Orontes on |
| Regimental number from Nominal Roll | 4058A |
| Rank from Nominal Roll | Private |
| Unit from Nominal Roll | 12th Battalion |
| Fate | Effective abroad (still overseas) |
Postal Address:
Po Box 7916
Canberra BC 2610, Australia
Street Address:
Northcott Drive,
Campbell, ACT 2600
