| Date of birth: | Jun 19, 1943 |
| Hair: | Gray |
| Eyes: | Brown |
| Number: | 00044201 |
| Booking date: | Mar 11, 2011 |
| Release date: | Mar 11, 2011 |
| Booking location: | Okaloosa County, FL |
| Statute: | 784.03-1a1 - BATTERY DOMV |
| Offense date: | Mar 10, 2011 |
| Bond amount: | $500 |
| Arrest date: | Mar 10, 2011 |