| Date of birth: | Jan 18, 1935 |
| Hair: | White |
| Eyes: | Brown |
| Unit description: | 220 Seippel Boulevard, Suite 2, Beaver Dam, WI 53916-0517, (920)885-2940 |
| Unit: | 7 05 |
| Photo date: | Sep 20, 2011 |
| Inmate status: | REVOKED |
| Booking number: | 00578016 |
| Booking location: | Polk County, WI |
| Statute: | 346.63(1)(A) M |
| County: | DODGE |
| Convicted: | Aug 15, 2011 |
| Case number: | 11CT222 |