| Date of birth: | Oct 27, 1955 |
| Hair: | Gray |
| Eyes: | Hazel |
| Inmate number: | 00021896 |
| Booking number: | 2005000108 |
| Booking date: | Jan 4, 2005 |
| Release date: | Jan 4, 2005 |
| Booking location: | Okaloosa County, FL |
| Statute: | 843.15 - COLUMBIA COUNTY FTA/WC |
| Offense date: | Jan 4, 2005 |
| Bond amount: | $350 |