| Date of birth: | May 31, 1964 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00019861 |
| Booking date: | Jul 5, 2004 |
| Release date: | Jul 14, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 941.02 - FFJ SIGNED WAIVER (NC) LARCENY/OBTAIN PROP BY FALSE PRETENSE |
| Offense date: | Jul 5, 2004 |