| Date of birth: | Apr 26, 1942 |
| Hair: | Blonde |
| Eyes: | Hazel |
| Residency: | Resident |
| Marital status: | Other |
| Juvenile: | No |
| Employment: | UNEMPLOYED |
| Education: | 14 |
| Birth place: | OHIO |
| Booking location: | Charlotte County, FL |
| Warrant: | 04740M |
| Statute description: | SIMPLE BATTERY (DOMESTIC) |
| Statute: | 784.03 1a1 |
| Offense date: | May 18, 2004 |
| Oca number: | 04013646 |
| Obts number: | 0801015079 |
| Level: | F |
| Depositer name: | MCGINNIS, PATRICK D |
| Court date: | Jun 2, 2004 |
| Charge: | M |
| Bond amount: | $1,000 |
| Bond agency: | MCGINNIS BAIL BONDS |
| Arresting officer: | BARAS, CHRISTOPHER |
| Arrest location: | 806 BURLAND ST |
| Agency: | FL0080000 |
