| Date of birth: | Mar 24, 1947 |
| Hold: | no |
| Booking number: | 1995-010537 |
| Booking date: | Jun 29, 1995 |
| Release date: | Jul 10, 1995 |
| Booking location: | Polk County, FL |
| Statute: | 784.03 BATTERY-NON SERIOUS INJURY |
| Charge on arrest docket: | BATTERY DOM VIOL |
| Charge number: | 1 |