| Date of birth: | May 6, 1943 |
| Hair: | Brown |
| Eyes: | Brown |
| Inmate number: | 00018172 |
| Booking number: | 2004000610 |
| Booking date: | Jan 26, 2004 |
| Release date: | Jan 27, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.03 - BATTERY (DOMV) |
| Offense date: | Jan 26, 2004 |