| Aircraft | |
| Serial Number | |
| Markings |
| Burial/Memorial Country | Canada |
| Burial/Memorial Place | Ottawa Memorial |
| Grave Reference | Panel 1. Column 5.. |
| Epitaph |
| Phase | 1 |
| Panel Number | 68 |
| Service Number | J/9859 |
| Service | Royal Canadian Air Force |
| Group | 1 |
| Squadron | 12 |
| Trade | |
| Country of origin if different | Canada |
| Start Date | 30-11--0001 |
| End Date | 30-11--0001 |
| Takeoff Station | |
| Day/Night raid | |
| Operation | |
| Reason for Loss |