| Date of birth: | 1945 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 376205 |
| SO#: | 203091 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9508868 |
| Booking date: | Apr 23, 1995 |
| Release date: | Apr 25, 1995 |
| Booking location: | Salt Lake County, UT |
| Number: | 921003168 |
| Amount: | $420 |