| Date of birth: | Mar 4, 1948 |
| Hair: | Gray |
| Eyes: | Hazel |
| Number: | 00020086 |
| Booking date: | Jul 24, 2004 |
| Release date: | Jul 28, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 812.014 - LEON COUNTY/ GT |
| Offense date: | Jul 24, 2004 |
| Bond amount: | $1,500 |
| Statute: | DEL.9999.999 - HOLD FOR LEON COUNTY |
| Offense date: | Jul 24, 2004 |
| Bond amount: | $1,500 |