| Date of birth: | Jan 11, 1948 |
| Hair: | Brown |
| Eyes: | Green |
| Number: | 00019875 |
| Booking date: | Jul 6, 2004 |
| Release date: | Jul 6, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 810.09 - TRESPASS W/ DANDEROUS WEAPON |
| Offense date: | Jul 6, 2004 |
| Bond amount: | $5,000 |