| Date of birth: | Apr 17, 1961 |
| Hair: | Brown |
| Eyes: | Hazel |
| Number: | 00021175 |
| Booking date: | Oct 27, 2004 |
| Release date: | Oct 27, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 316.193 - DRIVING UNDER THE INFLUENCE (REFUSED) |
| Offense date: | Oct 27, 2004 |
| Bond amount: | $1,000 |