| Date of birth: | 1940 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 228438 |
| SO#: | 128919 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0428454 |
| Booking date: | Dec 2, 2004 |
| Release date: | Dec 3, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $1,701 |