| Date of birth: | Jun 19, 1917 |
| Hold: | no |
| Booking number: | 1996-010460 |
| Booking date: | Jun 19, 1996 |
| Release date: | Jun 20, 1996 |
| Booking location: | Polk County, FL |
| Surety: | 1000 |
| Statute: | 784.021 AGG ASSAULT |
| Charge on arrest docket: | AGGRAVATED ASSAULT |
| Charge number: | 1 |
| Cash: | 250 |
| Bond type: | CBN |
| Bond number: | 00012609 |
| Bond amount: | $250 |