| Date of birth: | Mar 13, 1954 |
| Hold: | no |
| Arresting agency: | POLK COUNTY SHERIFF |
| Booking number: | 2005-001311 |
| Booking date: | Jan 18, 2005 |
| Release date: | Feb 18, 2005 |
| Booking location: | Polk County, FL |
| Statute: | 901.36(1) FRAUD-IMPERSON-FALSE ID GIVEN TO LEO |
| Charge on arrest docket: | GIVE FALSE NAME TO LEO |
| Charge number: | 1 |