| Date of birth: | Apr 26, 1984 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00045783 |
| Booking date: | Oct 5, 2011 |
| Release date: | Oct 5, 2011 |
| Booking location: | Okaloosa County, FL |
| Statute: | 843.15-1b - FTA , CM , PT |
| Offense date: | Oct 5, 2011 |
| Case number: | 11MM1968C |
| Bond amount: | $1,000 |
| Arrest date: | Oct 5, 2011 |