| Date of birth: | Sep 27, 1929 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2004-015909 |
| Booking date: | Jul 11, 2004 |
| Release date: | Jul 12, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 322.03(1) NONMOVING TRAFFIC VIOL-OPERATE MOTOR VEHICLE WO VA |
| Charge on arrest docket: | NVDL FTA DISP |
| Charge number: | 1 |