| Date of birth: | 1926 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 520312 |
| SO#: | 241644 |
| Booked at: | SALT LAKE |
| Cob: | New York |
| Booking number: | 9929817 |
| Booking date: | Dec 4, 1999 |
| Release date: | Dec 9, 1999 |
| Booking location: | Salt Lake County, UT |
| Amount: | $2,500 |