| Date of birth: | May 5, 1951 |
| Hold: | no |
| Arresting agency: | WINTER HAVEN POLICE DEPT. |
| Booking number: | 2004-027356 |
| Booking date: | Dec 2, 2004 |
| Release date: | Dec 3, 2004 |
| Booking location: | Polk County, FL |
| Statute: | 831.01 FORGERY OF-ALTER PUBLIC RECORD CERTIFICATE ETC |
| Charge on arrest docket: | FORGERY |
| Charge number: | 1 |
| Statute: | 831.02 PASS FORGED-ALTERED INSTRUMENT |
| Charge on arrest docket: | UTTERING A FORGED INSTRUMENT |
| Charge number: | 2 |
