| Date of birth: | Mar 28, 1945 |
| Hair: | Brown |
| Eyes: | Green |
| Inmate number: | 00048846 |
| Booking number: | 2012007140 |
| Booking date: | Dec 2, 2012 |
| Release date: | Dec 2, 2012 |
| Booking location: | Okaloosa County, FL |
| Statute: | 843.15-1b - FTA NVDL |
| Offense date: | Dec 2, 2012 |
| Case number: | 12-2881 |
| Bond amount: | $2,500 |