| Date of birth: | Oct 3, 1966 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00045089 |
| Booking date: | Jul 4, 2011 |
| Release date: | Jul 4, 2011 |
| Booking location: | Okaloosa County, FL |
| Statute: | 806.13-1b1 - MISC CRIM MISC |
| Offense date: | Jul 3, 2011 |
| Bond amount: | $250 |
| Arrest date: | Jul 3, 2011 |