| Date of birth: | Nov 18, 1965 |
| Hair: | Brown |
| Eyes: | Blue |
| Number: | 00019756 |
| Booking date: | Jun 26, 2004 |
| Release date: | Jul 9, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 948.06 - VOP/ FAIL TO LEAVE INS INFO; NO PROOF INS |
| Offense date: | Jun 26, 2004 |
| Case number: | 02CT1602S |
| Bond amount: | $875 |