| Date of birth: | Sep 4, 1957 |
| Hair: | Brown |
| Eyes: | Brown |
| Inmate number: | 00021299 |
| Booking number: | 2004007992 |
| Booking date: | Nov 7, 2004 |
| Release date: | Nov 8, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.03 - BATT (DOMV) |
| Offense date: | Nov 7, 2004 |
| Bond amount: | $1,000 |