| Date of birth: | Oct 14, 1939 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2004-020372 |
| Booking date: | Sep 7, 2004 |
| Release date: | Sep 20, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 784.011 SIMPLE ASSLT-INTENT THREAT TO DO VIOLENCE |
| Charge on arrest docket: | ASSLT-INTENT THREAT TO DO VIOLENCE (DV) |
| Charge number: | 1 |
| Bond type: | SBN |
| Bond number: | BB1504229 |
| Bond exp: | SBN BB1504229 $5000 PTR |
| Bond amount: | $5,000 |
