| Date of birth: | Mar 30, 1954 |
| Hold: | no |
| Booking number: | 1996-010465 |
| Booking date: | Jun 19, 1996 |
| Release date: | Jun 20, 1996 |
| Booking location: | Polk County, FL |
| Statute: | 784.03 BATTERY-NON SERIOUS INJURY |
| Charge on arrest docket: | BATTERY (DV) |
| Charge number: | 1 |