| Date of birth: | Dec 8, 1967 |
| Hair: | Brown |
| Eyes: | Green |
| Inmate number: | 00021192 |
| Booking number: | 2004007747 |
| Booking date: | Oct 28, 2004 |
| Release date: | Oct 29, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 893.13.6B - POM |
| Offense date: | Oct 28, 2004 |
| Bond amount: | $50 |