| Date of birth: | Oct 12, 1956 |
| Hair: | Black |
| Eyes: | Brown |
| Number: | 00025531 |
| Booking date: | Oct 12, 2005 |
| Release date: | Oct 12, 2005 |
| Booking location: | Okaloosa County, FL |
| Statute: | DEL.9999.999 - MEDICAID FRAUD |
| Offense date: | Oct 12, 2005 |
| Bond amount: | $5,000 |
| Statute: | 812.014 - GRANT THEFT |
| Offense date: | Oct 12, 2005 |
| Bond amount: | $5,000 |
| Statute: | 777.04 - CONSPIRACY |
| Offense date: | Oct 12, 2005 |
| Bond amount: | $5,000 |
