| Date of birth: | Nov 6, 1951 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2004-012966 |
| Booking date: | Jun 5, 2004 |
| Release date: | Jul 4, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 322.34(2A) NONMOVING TRAFFIC VIOL-DRIVE WHILE LIC SUSP 1ST OF |
| Charge on arrest docket: | KNOW DWLSR |
| Charge number: | 1 |