| Date of birth: | Mar 9, 1957 |
| Hold: | no |
| Booking number: | 1996-007524 |
| Booking date: | Apr 30, 1996 |
| Release date: | May 1, 1996 |
| Booking location: | Polk County, FL |
| Statute: | 784.03 BATTERY-NON SERIOUS INJURY |
| Charge on arrest docket: | BATTERY DV |
| Charge number: | 1 |
| Bond type: | CBN |
| Bond number: | 00012113 |
| Bond amount: | $1,500 |