| Date of birth: | 1932 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 101429 |
| SO#: | 31999 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0421661 |
| Booking date: | Sep 9, 2004 |
| Release date: | Sep 13, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 04CR10471 |
| Amount: | $1,000 |
| Number: | 04CR10638 |
| Amount: | $1,500 |
