| Date of birth: | Jan 6, 1962 |
| Hold: | no |
| Booking number: | 1996-013931 |
| Booking date: | Aug 18, 1996 |
| Release date: | Aug 30, 1996 |
| Booking location: | Polk County, FL |
| Statute: | 784.03 BATTERY-NON SERIOUS INJURY |
| Charge on arrest docket: | BATT DV ORD REV PTR |
| Charge number: | 1 |