| Date of birth: | Sep 28, 1933 |
| Hair: | Brown |
| Eyes: | Blue |
| Inmate number: | 00021493 |
| Booking number: | 2004008476 |
| Booking date: | Nov 27, 2004 |
| Release date: | Nov 28, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.021 - AGGRAVATED ASSAULT |
| Offense date: | Nov 27, 2004 |