| Date of birth: | Oct 12, 1922 |
| Hold: | no |
| Booking number: | 1993-015570 |
| Booking date: | Nov 16, 1993 |
| Release date: | Nov 19, 1993 |
| Booking location: | Polk County, FL |
| Surety: | 5000 |
| Statute: | 784.03 BATTERY-NON SERIOUS INJURY |
| Charge on arrest docket: | BATTERY/DV |
| Charge number: | 1 |
| Bond type: | SBN |
| Bond number: | IC-802589 |