| Date of birth: | Aug 15, 1954 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2013-025720 |
| Booking date: | Nov 21, 2013 |
| Booking location: | Polk County, FL |
| Statute: | 775.21(6) SEX PREDATOR REGISTRATION (NOT AN ARREST) |
| Charge on arrest docket: | VIOL OF SEXUAL OFF RESIDENCY REST - SENT |
| Charge number: | 1 |