| Booking number: | 0191600541 |
| Booking date: | May 4, 2016 |
| Release date: | May 4, 2016 |
| Jail name: | Bedford Adult Detention Facility |
| Location: | 1000 Broad St, Bedford, VA 24523 |
| Statute: | 18.2-308.2:2(K) |
| Description: | FALSE STATEMENT ON FIREARM CONSENT FORM |
| Case number: | CR16000140-00 |
| Offense date: | Nov 12, 2015 |
| Arrest date: | May 4, 2016 |