| Date of birth: | Jan 29, 1954 |
| Hair: | Brown |
| Eyes: | Blue |
| Inmate number: | 00021548 |
| Booking number: | 2004008619 |
| Booking date: | Dec 4, 2004 |
| Release date: | Dec 4, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | DEL.9999.999 - WELFARE FRAUD |
| Offense date: | Dec 4, 2004 |
| Bond amount: | $1,500 |