| Date of birth: | Aug 11, 1957 |
| Hair: | Gray |
| Eyes: | Brown |
| Number: | 00039609 |
| Booking date: | Jul 1, 2009 |
| Release date: | Jul 22, 2009 |
| Booking location: | Okaloosa County, FL |
| Statute: | 741.31-4a - VIOL INJUNCTION DOMESTIC VIOLENCE |
| Offense date: | Jul 1, 2009 |
| Case number: | 09MM2548 |
| Arrest date: | Jul 1, 2009 |