| Date of birth: | Jun 4, 1973 |
| Hair: | Black |
| Eyes: | Brown |
| Booking number: | 2012012612 |
| Booking date: | Nov 2, 2012 |
| Booking location: | Manatee County, FL |
| Statute: | 440.105-4B |
| Seq: | 1 |
| Obts: | 4105043719 |
| Description: | MISREP OMIT INFO RE WORK COMP CLAIM LESS $20K |
| Date arrest: | Nov 2, 2012 |
| Charge: | MISREP OMIT INFO RE WORK COMP CLAIM LESS $20K |
| Book date: | Nov 2, 2012 |
| Book: | 2012012612 |
| Bond amount: | $1,500 |