| Date of birth: | Sep 24, 1917 |
| Hair: | Grey or partially grey |
| Eyes: | Brown |
| SO#: | 116240 |
| Arresting agency: | Department of Public Safety |
| Booking number: | 63156 |
| Booking date: | Feb 15, 2004 |
| Release date: | Feb 15, 2004 |
| Booking location: | Brazoria County, TX |
| Warrant: | DJ005494 |
| Offense date: | Feb 15, 2004 |
| Issuing authority: | JP 2/2 |
| Charge: | DRIVING WHILE INTOXICATED |