| Date of birth: | Dec 25, 1953 |
| Hair: | Brown |
| Eyes: | Hazel |
| Number: | 00019652 |
| Booking date: | Jun 18, 2004 |
| Release date: | Jun 25, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 941.02 - FFJ/ILLINOIS (WAIVER SIGNED) (AGGRAVATED BATTERY) |
| Offense date: | Jun 18, 2004 |
| Statute: | DEL.9999.999 - HOLD FOR COOK CO |
| Offense date: | Jun 18, 2004 |