| Date of birth: | Sep 8, 1932 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2011-027417 |
| Booking date: | Nov 22, 2011 |
| Release date: | Nov 23, 2011 |
| Booking location: | Polk County, FL |
| Statute: | 784.03(1A1) BATTERY-TOUCH OR STRIKE |
| Charge on arrest docket: | BATTERY TOUCH OR STRIKE (DV) |
| Charge number: | 1 |