| Date of birth: | Jun 27, 1943 |
| Hair: | Brown |
| Eyes: | Brown |
| Inmate number: | 00019065 |
| Booking number: | 2004002890 |
| Booking date: | Apr 25, 2004 |
| Release date: | Apr 25, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.021 - AGGRAVATED ASSAULT ON LEO |
| Offense date: | Apr 25, 2004 |
| Bond amount: | $10,000 |
| Statute: | 843.02 - RAWOV |
| Offense date: | Apr 25, 2004 |
| Bond amount: | $10,000 |
