| Date of birth: | Apr 18, 1951 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2004-015412 |
| Booking date: | Jul 4, 2004 |
| Release date: | Jul 5, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 784.03(1A1) BATTERY-TOUCH OR STRIKE |
| Charge on arrest docket: | DOMESTIC BATTERY |
| Charge number: | 1 |
| Bond type: | SBN |
| Bond number: | AA04377951 |
| Bond exp: | SBN AA04-377951 $500 PTR |
| Bond amount: | $500 |