| Date of birth: | Dec 17, 1939 |
| Hair: | Black |
| Eyes: | Brown |
| SO#: | 34182 |
| Arresting agency: | Clute Police Department |
| Booking number: | 72762 |
| Booking date: | Oct 15, 2004 |
| Release date: | Oct 15, 2004 |
| Booking location: | Brazoria County, TX |
| Warrant: | A040777 |
| Offense date: | Oct 15, 2004 |
| Issuing authority: | 1-1 |
| Charge: | FICTITIOUS COUNTERFEIT INSP/INS DOC FOR DISPLAY |
| Bond type: | $1,000 Bail Bond |