| Date of birth: | 1945 |
| Hair: | Black |
| Eyes: | Brown |
| SO#: | 000036351 |
| Releasing officer: | 002525 |
| Comments: | A/T BASTIS W/G BRANNEN OTN/116204045 |
| Birth place: | GA |
| Arresting agency: | GA0330200 |
| Arrest number: | 000431211 |
| Arrest date: | May 2, 2004 |
| Arrest location: | VET MEM HWY |
| Booking date: | May 2, 2004 |
| Booking location: | Cobb County, GA |
| Warrant date: | May 2, 2004 |
| Warrant: | 699464 |
| Type: | MU |
| Section: | 40-5-121 |
| Offense date: | May 2, 2004 |
| Description: | REV/SUSP. DR. LIC. |
| Counts: | 01/ |
| Code: | OCGA |
| Bond amount: | $500 |
| Warrant date: | May 2, 2004 |
| Warrant: | 699465 |
| Type: | MU |
| Section: | 40-2-8 |
| Offense date: | May 2, 2004 |
| Description: | NO TAG |
| Counts: | 01/ |
| Code: | OCGA |
| Bond amount: | $100 |
