| Regimental number | 4/2019 |
| Occupation | Tanner |
| Next of kin | Mother, Mrs K Wysockie, York Street, Dannevirke |
| Rank on embarkation | Sapper |
| Unit name | New Zealand Expeditionary Force, 10th Reinforcements, New Zealand Engineers |
| Embarkation details | Unit embarked from Wellington on |
| Sources | Nominal Roll Vol. 2: Roll 26, p. 23 |