| Date of birth: | 1933 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 451716 |
| SO#: | 212353 |
| Booked at: | SALT LAKE |
| Cob: | Florida |
| Booking number: | 9614013 |
| Booking date: | Jul 31, 1996 |
| Release date: | Aug 22, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 961014045 |
| Amount: | $1,000 |