| Date of birth: | Apr 28, 1975 |
| Hair: | Brown |
| Eyes: | Brown |
| Number: | 00044072 |
| Booking date: | Feb 21, 2011 |
| Release date: | Feb 25, 2011 |
| Booking location: | Okaloosa County, FL |
| Statute: | 831.30-1 - FORGERY/ALTER PRESC |
| Offense date: | Feb 21, 2011 |
| Bond amount: | $2,000 |
| Arrest date: | Feb 21, 2011 |