| Date of birth: | Nov 23, 1963 |
| Hair: | Black |
| Eyes: | Brown |
| Number: | 00021205 |
| Booking date: | Oct 30, 2004 |
| Release date: | Oct 30, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 948.06 - VOP/WC |
| Offense date: | Oct 30, 2004 |
| Case number: | 03MM5568 |
| Bond amount: | $350 |
| Statute: | 832.05 - WC(2 COUNTS) |
| Offense date: | Oct 30, 2004 |
| Case number: | 03MM5568 |
| Bond amount: | $350 |
