| Date of birth: | Oct 24, 1942 |
| Hair: | Gray |
| Eyes: | Brown |
| Inmate number: | 00020484 |
| Booking number: | 2004006135 |
| Booking date: | Aug 30, 2004 |
| Release date: | Dec 21, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 948.06 - VOP/GT,GTA |
| Offense date: | Aug 30, 2004 |
| Case number: | 98CF1341 |