| Date of birth: | Jun 28, 1950 |
| Hair: | Black |
| Eyes: | Brown |
| Number: | 00001340 |
| Booking date: | Jan 4, 2000 |
| Release date: | Jan 4, 2000 |
| Booking location: | Okaloosa County, FL |
| Statute: | DEL.9999.999 - FALSE REPORT OF CRIME |
| Offense date: | Jan 4, 2000 |
| Case number: | 12178-99 |
| Bond amount: | $500 |