| Date of birth: | May 22, 1959 |
| Hold: | no |
| Booking number: | 1996-007339 |
| Booking date: | Apr 28, 1996 |
| Release date: | Apr 28, 1996 |
| Booking location: | Polk County, FL |
| Surety: | 1000 |
| Statute: | 784.03 BATTERY-NON SERIOUS INJURY |
| Charge on arrest docket: | BATT DV FTA DOCK |
| Charge number: | 1 |
| Cash: | 250 |
| Bond type: | CBN |
| Bond number: | 00011979 |
| Bond amount: | $250 |