| Regimental number | 71004 |
| Occupation | Miner |
| Next of kin | Mother, Mrs Margaret Blackley, Burnside, Green Island |
| Rank on embarkation | Private |
| Unit name | New Zealand Expeditionary Force, 35th Reinforcements, C Company |
| Embarkation details | Unit embarked from Wellington on board HMNZT 101 Tofua on |
| Sources | Nominal Rolls Vol. 4: Roll 80, p. 9 |