| Date of birth: | Aug 29, 1956 |
| Inmate location: | SOUTH JAIL BLDG 7 DORM P |
| Booking number: | 2016-003211 |
| Booking date: | Jan 26, 2016 |
| Booking location: | Polk County, FL |
| Statute: | 327.352 Refuse to Submit to Urine/Breath Test |
| Charge on arrest docket: | >FAILURE TO SUBMIT TO BREATHALYZER |