| Date of birth: | Mar 22, 1962 |
| Hair: | Brown |
| Eyes: | Hazel |
| Inmate number: | 00019008 |
| Booking number: | 2004002729 |
| Booking date: | Apr 19, 2004 |
| Release date: | Apr 20, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 948.06 - VOP/POM |
| Offense date: | Apr 19, 2004 |
| Case number: | 02-MM-1013-S |
| Bond amount: | $500 |