| Date of birth: | Nov 25, 1942 |
| Hair: | Gray |
| Eyes: | Hazel |
| Inmate number: | 00019676 |
| Booking number: | 2004004362 |
| Booking date: | Jun 19, 2004 |
| Release date: | Jun 21, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 893.13 - POP/POM/POC |
| Offense date: | Jun 19, 2004 |
| Case number: | 03-CF-1779 |