| Date of birth: | Aug 11, 1944 |
| Hair: | Black |
| Eyes: | Hazel |
| Inmate number: | 00022019 |
| Booking number: | 2005000385 |
| Booking date: | Jan 12, 2005 |
| Release date: | Jan 12, 2005 |
| Booking location: | Okaloosa County, FL |
| Statute: | 832.05 - WC |
| Offense date: | Jan 12, 2005 |
| Case number: | 04-MM-12625-C |
| Bond amount: | $750 |