| Date of birth: | Dec 19, 1957 |
| Hair: | Black |
| Eyes: | Brown |
| Spn: | 169877 |
| Booking location: | Leon County, FL |
| Statute: | 893.13 7A9 |
| Release date: | Sep 22, 2004 |
| Offense date: | Sep 22, 2004 |
| Clerk case: | 2004CF3352A1 |
| Charge literal: | OBTAINING OR ATTEMPTING TO OBTAIN A CONTROLLED SUBSTANCE BY FORGERY, MISREPRESENTATION, FRAUD OR SUBTERFUGE |
| Booking date: | Sep 22, 2004 |
| Booking agency: | TALLAHASSEE POLICE DEPARTMENT |
| Agency report: | 04030945 |