| Date of birth: | 1953 |
| Hair: | Gray |
| Eyes: | Brown |
| SO#: | 000031447 |
| Releasing officer: | 002757 |
| Comments: | A/T FULLER T/WT DESASSURE W/G LOPS OTN/117574015 |
| Birth place: | AL |
| Arresting agency: | GA0330200 |
| Arrest number: | 000443379 |
| Arrest date: | Aug 31, 2004 |
| Arrest location: | VMH @ PEBBLEBROOK |
| Booking date: | Aug 31, 2004 |
| Booking location: | Cobb County, GA |
| Warrant date: | Aug 31, 2004 |
| Warrant: | 779417 |
| Type: | MU |
| Section: | 40-5-121 |
| Offense date: | Aug 31, 2004 |
| Description: | REV/SUSP. DR. LIC. |
| Counts: | 01/ |
| Code: | OCGA |
| Bond amount: | $500 |
