| Date of birth: | Jul 4, 1937 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2004-020232 |
| Booking date: | Sep 4, 2004 |
| Release date: | Sep 6, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 741.31(4A) CONTEMPT OF COURT-VIOL INJUNCTION PROTECTION DOMES |
| Charge on arrest docket: | VIOL OF INJUNCTION AGAINST DV |
| Charge number: | 1 |