| Date of birth: | Jan 17, 1957 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00017091 |
| Booking date: | Apr 11, 2005 |
| Release date: | Apr 11, 2005 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.011 - ASSAULT DOMV |
| Offense date: | Apr 11, 2005 |
| Statute: | 806.13 - CRIMINAL MISCHIEF |
| Offense date: | Apr 11, 2005 |