| Date of birth: | Jun 29, 1942 |
| Hold: | no |
| Booking number: | 1995-018963 |
| Booking date: | Nov 22, 1995 |
| Release date: | Nov 22, 1995 |
| Booking location: | Polk County, FL |
| Statute: | 784.03 BATTERY-NON SERIOUS INJURY |
| Charge on arrest docket: | BATTERY DV (FTA DOCK) |
| Charge number: | 1 |