| Date of birth: | Jan 18, 1969 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00017610 |
| Booking date: | Nov 28, 2003 |
| Release date: | Nov 28, 2003 |
| Booking location: | Okaloosa County, FL |
| Statute: | 316.193 - DUI(REFUSAL) |
| Offense date: | Nov 28, 2003 |
| Statute: | DEL.9999.999 - REFUSAL SUBMIT SAMPLE OF BREATH |
| Offense date: | Nov 28, 2003 |