| Date of birth: | Jan 22, 1957 |
| Hair: | Gray |
| Eyes: | Brown |
| Inmate number: | 00018924 |
| Booking number: | 2004002529 |
| Booking date: | Apr 10, 2004 |
| Release date: | May 20, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.07 - AGG ASSAULT ON LEO |
| Offense date: | Apr 10, 2004 |