| Date of birth: | 1964 |
| Arrest number: | 2012000000320 |
| Arrest officer: | Bullock Adam J |
| Booking officer: | Charland Timothy R |
| Booking type: | Arrest |
| Booking location: | Worcester County, MA |
| Statute id: | 265/13A/B |
| Law description: | A&B |
| Statute id: | 272/53/G |
| Law description: | Disturbing the Peace |