| Date of birth: | May 5, 1959 |
| Hair: | Brown |
| Eyes: | Brown |
| Inmate number: | 00020771 |
| Booking number: | 2004006778 |
| Booking date: | Sep 24, 2004 |
| Release date: | Sep 30, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 322.34 - DWLSR |
| Offense date: | Sep 24, 2004 |
| Bond amount: | $1,500 |