| Date of birth: | Apr 13, 1961 |
| Hair: | Black |
| Eyes: | Brown |
| Number: | 00021104 |
| Booking date: | Oct 21, 2004 |
| Release date: | Nov 11, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 316.193 - DUI/SERIOUS BODILY INJURY |
| Offense date: | Oct 21, 2004 |
| Case number: | 04CF2360 |
| Bond amount: | $25,000 |