| Date of birth: | Jul 4, 1936 |
| Hair: | Gray |
| Eyes: | Blue |
| Inmate number: | 00022087 |
| Booking number: | 2005000531 |
| Booking date: | Jan 18, 2005 |
| Release date: | Jan 18, 2005 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.03 - BATTERY (SIMPLE) |
| Offense date: | Jan 18, 2005 |
| Case number: | 04-14464 |
| Bond amount: | $1,000 |