| Hair: | Grey or partially grey |
| Eyes: | Brown |
| SO#: | P01016460 |
| Arresting agency: | Doctor Visit (added for converted Tiburon data only |
| Booking number: | 1138786 |
| Booking date: | Nov 10, 2011 |
| Release date: | Dec 21, 2011 |
| Booking location: | Fulton County, GA |
| Charge: | U/S SBPP EF#675191 |
| Bond type: | $0 Other |