| Date of birth: | 1951 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 600774 |
| SO#: | 277027 |
| Booked at: | SALT LAKE |
| Cob: | Arizona |
| Citizen: | UNITED STATES |
| Booking number: | 0330678 |
| Booking date: | Dec 9, 2003 |
| Release date: | Dec 9, 2003 |
| Booking location: | Salt Lake County, UT |
| Amount: | $200 |