| Date of birth: | Jul 25, 1940 |
| Hair: | Brown |
| Eyes: | Hazel |
| Number: | 00039760 |
| Booking date: | Jul 16, 2009 |
| Release date: | Jul 16, 2009 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.03-1a1 - BATTERY (DOMV) |
| Offense date: | Jul 15, 2009 |
| Bond amount: | $1,000 |
| Arrest date: | Jul 15, 2009 |