| Date of birth: | May 7, 1957 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2004-014273 |
| Booking date: | Jun 21, 2004 |
| Release date: | Jun 22, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 812.014(3A) LARC-PETIT 1ST OFF |
| Charge on arrest docket: | THEFT-PETIT RETAIL |
| Charge number: | 1 |
| Bond type: | CBN |
| Bond number: | 04-001334 |
| Bond exp: | 04-001334 FOR 250 |
| Bond amount: | $250 |