| Date of birth: | May 31, 1963 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00018504 |
| Booking date: | Mar 2, 2004 |
| Release date: | Mar 2, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 499.03 - (2CTS)POSS. LEGEND DRUG W/OUT PRESCRIPTION |
| Offense date: | Mar 2, 2004 |
| Statute: | 893.13 - POM |
| Offense date: | Mar 2, 2004 |
| Statute: | 893.13 - POP |
| Offense date: | Mar 2, 2004 |