| Date of birth: | Sep 5, 1934 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 1997-018349 |
| Booking date: | Sep 27, 1997 |
| Release date: | Sep 28, 1997 |
| Booking location: | Polk County, FL |
| Statute: | 784.021 AGG ASSAULT |
| Charge on arrest docket: | AGG ASSLT |
| Charge number: | 1 |