| Date of birth: | Oct 31, 1961 |
| Hair: | Gray |
| Eyes: | Brown |
| Inmate number: | 00048399 |
| Booking number: | 2012005861 |
| Booking date: | Oct 2, 2012 |
| Release date: | Oct 11, 2012 |
| Booking location: | Okaloosa County, FL |
| Statute: | 941.02 - OUT-OF-STATE-FUG-ARIZONA/MARICOPA/INSURANCE FRAUD |
| Offense date: | Oct 1, 2012 |