| Date of birth: | Jul 27, 1945 |
| Hold: | no |
| Arresting agency: | FORT MEADE POLICE DEPT. |
| Booking number: | 2004-025360 |
| Booking date: | Nov 6, 2004 |
| Release date: | Nov 7, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 893.147(1) NARCOTIC EQUIP-POSSESS-AND OR USE |
| Charge on arrest docket: | POSS OF DRUG PARA |
| Charge number: | 1 |