| Date of birth: | 1961 |
| Unit description: | 941 Mallard Lane; #105; Balsam Lake, WI 54810; (715)485-3114 |
| Unit: | 5 08 |
| Pin number: | 273971 |
| Photo date: | Jul 19, 2010 |
| Booking number: | 00231312 |
| Booking location: | Polk County, WI |
| Statute: | UNKNOWN - IC , UNKNOWN - IC U |
| County: | OUT-OF-STATE |