| Date of birth: | Sep 9, 1979 |
| Hair: | Brown |
| Eyes: | Hazel |
| SO#: | 00100132 |
| Sid: | 14610012 |
| Booking location: | Jackson County, OR |
| Lodging date: | Oct 2, 2015 |
| Charge: | 0162.195 FP FALSE INFO / FAIL TO APPEAR 2ND DEG - 1~PV FALSE |
| Bond amount: | $4,000 |
| Arresting agency: | MFP |