| Date of birth: | Sep 30, 1958 |
| Booking date: | Oct 10, 2013 |
| Booking location: | Effingham County, GA |
| Code: | 16-13-78 |
| Charge description: | OBTAINING OR ATTEMPTING TO OBTAIN REGULATED DRUGS BY FRAUD, FORGERY, CONCEALMENT OF MATERIAL FACT, OR USE OF FALSE NAME OR ADDRESS |