| Date of birth: | Aug 26, 1961 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2012-028970 |
| Booking date: | Nov 17, 2012 |
| Release date: | Nov 18, 2012 |
| Booking location: | Polk County, FL |
| Statute: | 784.03(1A1) BATTERY-TOUCH OR STRIKE |
| Charge on arrest docket: | BATTERY DOMESTIC VIOLENCE |
| Charge number: | 1 |