| Date of birth: | Nov 9, 1941 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00043362 |
| Booking date: | Oct 29, 2010 |
| Release date: | Oct 29, 2010 |
| Booking location: | Okaloosa County, FL |
| Statute: | 832.05-2 - WC |
| Offense date: | Oct 29, 2010 |
| Case number: | 09-MM-10044 |
| Bond amount: | $281.91 |
| Arrest date: | Oct 29, 2010 |