| Date of birth: | Oct 28, 1937 |
| Hair: | Gray |
| Eyes: | Green |
| Inmate number: | 00015809 |
| Booking number: | 2003003359 |
| Booking date: | Jun 7, 2003 |
| Release date: | Jun 7, 2003 |
| Booking location: | Okaloosa County, FL |
| Statute: | DEL.9999.999 - WORKERS COMPENSATION FRAUD |
| Offense date: | Jun 7, 2003 |
| Bond amount: | $500 |