| Date of birth: | 1950 |
| Hair: | Brown |
| Eyes: | Blue |
| SO#: | 000056199 |
| Releasing officer: | 097030 |
| Duration of custody: | 530 |
| Comments: | W/G/STOREY OTN/110001754 |
| Birth place: | IN |
| Type: | 14 |
| Side: | R |
| Description: | D H |
| Body part: | H |
| Type: | 24 |
| Side: | R |
| Description: | JESUS ON THE CROSS |
| Body part: | C |
| Type: | OT |
| Side: | R |
| Description: | LIGHTENING BOLT |
| Body part: | A |
| Type: | OT |
| Side: | R |
| Description: | UNICORN,MOON,CLOUDS |
| Body part: | A |
| Type: | OT |
| Side: | R |
| Description: | DRAGON,SNAKE |
| Body part: | A |
| Arresting agency: | GA0330000 |
| Arrest number: | 000438638 |
| Arrest date: | Jul 16, 2004 |
| Arrest location: | COBB/ FULTON LINE |
| Booking date: | Jul 16, 2004 |
| Booking officer: | 001075 |
| Booking location: | Cobb County, GA |
| Warrant date: | Jun 11, 2004 |
| Warrant: | 02-0766 |
| Type: | FI |
| Section: | 42-8-38 |
| Description: | VIOL. OF PROBATION |
| Counts: | 01/ |
| Code: | OCGA |
| Bond amount: | No bail |
