| Date of birth: | Sep 16, 1939 |
| Hair: | Gray |
| Eyes: | Blue |
| Inmate status: | N |
| Inmate number: | 11009244 |
| Booking number: | B11015625 |
| Booking date: | Nov 9, 2011 |
| Booking age: | 1972 |
| Release date: | Nov 10, 2011 |
| Booking location: | Walton County, FL |
| Violation level: | F |
| Violation description 2: | CONCEAL INFO TO OBTAIN PRESCRIPTION X4 |
| Violation description: | CONCEAL INFO TO OBTAIN PRESCRIPTION |
| Violation code: | 893.13(7A8) |
| Required cash amount: | $2,500 |
| Obts: | 6601038797 |
| Clear type: | SURETY |
| Charge number: | 1 |
| Bond type: | SURETY/CASH |
| Bond number: | AS3K-169016 |
| Bond group: | 2500 |
| Bond amount: | $2,500 |
| Arrest date: | Nov 9, 2011 |
