| Booking number: | 190914716 |
| Booking date: | Jan 12, 2009 |
| Release date: | Jan 12, 2009 |
| Jail name: | Bedford Adult Detention Facility |
| Location: | 1000 Broad St, Bedford, VA 24523 |
| Statute: | 18.2-308.2:2(K) |
| Description: | FALSE STATEMENTS ON CONSENT FORM |
| Arrest date: | Jan 12, 2009 |