| Date of birth: | Sep 3, 1941 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2003-019041 |
| Booking date: | Aug 31, 2003 |
| Release date: | Mar 17, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 948.06 PROB VIOLATION-OR COMMTY CONT RE UNK/FEL/MISD/JUV |
| Charge on arrest docket: | VOP WELFARE FRAUD |
| Charge number: | 1 |