| Date of birth: | Jul 21, 1958 |
| Ethnicity: | N |
| Prisoner number: | 01-0003367 |
| Arrest number: | SC0340000 |
| Booking location: | Marion County, SC |
| Ticket warrant: | 2013A3310100222 |
| Statute: | 43-07-0070 |
| Description: | FALSE / FALSE STATEMENT ON APPLICATION FOR MEDICAID ASSISTANCE |
| Cdr: | 2419 |
| Bond amount: | $5,000 |