| Date of birth: | Feb 6, 1942 |
| Hair: | Salt/pepper |
| Eyes: | Brown |
| Inmate number: | 00017755 |
| Booking number: | 2003007792 |
| Booking date: | Dec 13, 2003 |
| Release date: | Dec 14, 2003 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.03 - BATTERY/ DOMV |
| Offense date: | Dec 13, 2003 |