| Date of birth: | 1946 |
| Hair: | Gray |
| Eyes: | Blue |
| SO#: | 000017429 |
| Releasing officer: | 002560 |
| Duration of custody: | 4 |
| Comments: | A/T D MOSS W/G-HARRIS OTN/118816611 |
| Birth place: | MS |
| Type: | 24 |
| Side: | L |
| Description: | CROSS NEAR HAND |
| Body part: | A |
| Type: | 14 |
| Side: | L |
| Description: | SMILE GOD LOVES YOU |
| Body part: | A |
| Type: | 09 |
| Side: | L |
| Description: | ROSE & HEART |
| Body part: | A |
| Arresting agency: | GA0330200 |
| Arrest number: | 000450237 |
| Arrest date: | Nov 8, 2004 |
| Arrest location: | SMYRNA POWDER SPG/SHARON DR |
| Booking date: | Nov 8, 2004 |
| Booking location: | Cobb County, GA |
| Warrant date: | Nov 8, 2004 |
| Warrant: | 727038 |
| Type: | MU |
| Section: | 40-8-76.1 |
| Offense date: | Nov 8, 2004 |
| Description: | NOT WEARING SEAT BLT |
| Counts: | 01/ |
| Code: | OCGA |
| Bond amount: | $100 |
| Warrant date: | Nov 8, 2004 |
| Warrant: | 727039 |
| Type: | MU |
| Section: | 40-5-121 |
| Offense date: | Nov 8, 2004 |
| Description: | REV/SUSP. DR. LIC. |
| Counts: | 01/ |
| Code: | OCGA |
| Bond amount: | $500 |
| Warrant: | 04M5260 |
| Type: | MI |
| Section: | 17-6-12 |
| Description: | FAILURE TO APPEAR |
| Counts: | 01/IN |
| Code: | OCGA |
| Bond amount: | No bail |
