| Date of birth: | Jun 12, 1949 |
| Hair: | Gray |
| Eyes: | Brown |
| Number: | 00017864 |
| Booking date: | Dec 25, 2003 |
| Release date: | Dec 26, 2003 |
| Booking location: | Okaloosa County, FL |
| Statute: | 948.06 - SANTA ROSA CO. VOP/FELONY WC |
| Offense date: | Dec 25, 2003 |
| Case number: | 01-1471-WCA |