| Date of birth: | Feb 8, 1959 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2004-002515 |
| Booking date: | Feb 1, 2004 |
| Release date: | Feb 2, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 784.03(1A1) BATTERY-TOUCH OR STRIKE |
| Charge on arrest docket: | BATTERY DV |
| Charge number: | 1 |