| Date of birth: | Jul 29, 1963 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00043141 |
| Booking date: | Sep 26, 2010 |
| Release date: | Sep 26, 2010 |
| Booking location: | Okaloosa County, FL |
| Statute: | 440.105-4a3 - EMP NOT GET WORK COMP INS 100K DOLS OR MORE |
| Offense date: | Sep 26, 2010 |
| Case number: | DIF106762 |