| Date of birth: | Sep 17, 1961 |
| Hair: | Salt/pepper |
| Eyes: | Blue |
| Number: | 00020586 |
| Booking date: | Sep 8, 2004 |
| Release date: | Sep 8, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 948.06 - VIOLATION OF PROBATION/DWLSR |
| Offense date: | Sep 8, 2004 |
| Case number: | 04-CT-81-C |
| Bond amount: | $566 |