| Date of birth: | Jan 31, 1940 |
| Hair: | Gray |
| Eyes: | Brown |
| Inmate status: | N |
| Inmate number: | 09005676 |
| Booking number: | B09005971 |
| Booking date: | Jun 26, 2009 |
| Booking age: | 1969 |
| Release date: | Jun 26, 2009 |
| Booking location: | Walton County, FL |
| Violation level: | M |
| Violation description: | MAKE ALTER PRESCRIPTION 1ST OFF |
| Violation code: | 831.30(1) |
| Obts: | 6601032387 |
| Charge number: | 1 |
| Arrest location: | PUBLIX PHARMACY MIRAMAR BCH |
| Arrest date: | Jun 26, 2009 |
| Agency case: | 09006471 |
| Violation level: | F |
| Violation description: | CNTRL SUB WO PRESCRIPTION |
| Violation code: | 893.13(6a) |
| Obts: | 6601032387 |
| Charge number: | 2 |
| Arrest location: | PUBLIX PHARMACY MIRAMAR BCH |
| Arrest date: | Jun 26, 2009 |
| Agency case: | 09006471 |
