| Date of birth: | May 16, 1927 |
| Hair: | Gray |
| Eyes: | Blue |
| Number: | 00016009 |
| Booking date: | Jun 25, 2003 |
| Release date: | Jul 16, 2003 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.07 - ASSAULT OR BATTERY ON LAW ENFORCEMENT OFFICER/FIREFIG |
| Offense date: | Jun 25, 2003 |
| Statute: | 784.011 - ASSAULT (DOMV) |
| Offense date: | Jun 25, 2003 |