| Date of birth: | Jun 21, 1962 |
| Hair: | Brown |
| Eyes: | Hazel |
| Number: | 00024410 |
| Booking date: | Jul 12, 2005 |
| Release date: | Jul 15, 2005 |
| Booking location: | Okaloosa County, FL |
| Statute: | 843.15 - FTA/ATTACH TAG NOT ASSIGNED |
| Offense date: | Jul 12, 2005 |
| Case number: | 04CT236S |
| Bond amount: | $250 |