| Date of birth: | Nov 25, 1955 |
| Hair: | Grey |
| Eyes: | Hazel |
| Skin tone: | LIGHT |
| Nationality: | AMERICAN |
| Build: | MEDIUM |
| Booking location: | Pottawatomie County, OK |
| Offense date: | Jan 1, 1900 |
| Description: | FALSE SECURITY VERIFICATION FORM |
| Code: | 470007602B |
| Case number: | CF-2017-185 |