| Date of birth: | Mar 14, 1959 |
| Hold: | no |
| Arresting agency: | OTHER |
| Booking number: | 2011-022105 |
| Booking date: | Sep 19, 2011 |
| Booking location: | Polk County, FL |
| Surety: | 1000 |
| Statute: | 943.0435 SEX OFFENDER REGISTRATION (NOT AN ARREST) |
| Charge on arrest docket: | FAIL TO REGISTER CHANGE OF ADDRESS SEX O |
| Charge number: | 1 |
| Cash: | 1000 |