| Date of birth: | May 12, 1946 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00019586 |
| Booking date: | Jun 12, 2004 |
| Release date: | Jun 12, 2004 |
| Booking location: | Okaloosa County, FL |
| Statute: | 316.193 - DUI(PENDING URINE RESULT) |
| Offense date: | Jun 12, 2004 |
| Bond amount: | $500 |