| Date of birth: | Sep 11, 1956 |
| Hair: | Brown |
| Eyes: | Brown |
| Inmate number: | 00015933 |
| Booking number: | 2003007619 |
| Booking date: | Dec 5, 2003 |
| Release date: | Dec 22, 2003 |
| Booking location: | Okaloosa County, FL |
| Statute: | 948.06 - VOP/GT,UFI |
| Offense date: | Dec 5, 2003 |
| Case number: | 03CF1199 |