| Regimental number | 1504 |
| Place of birth | Mildura Victoria |
| Religion | Church of England |
| Occupation | Labourer |
| Address | c/o Mrs. Jane Smith, Renmark, South Australia |
| Marital status | Single |
| Age at embarkation | 19 |
| Next of kin | Mother, Mrs. Jane Smith, Renmark, South Australia |
| Enlistment date | 15 June 1915 |
| Rank on enlistment | Private |
| Unit name | 3rd Light Horse Regiment, 11th Reinforcement |
| AWM Embarkation Roll number | 10/8/3 |
| Embarkation details | Unit embarked from Adelaide, South Australia, on board HMAT A24 Benalla on 27 October 1915 |
| Rank from Nominal Roll | Corporal |
| Unit from Nominal Roll | a PROV C |
| Fate | Returned to Australia 24 July 1919 |
