| Date of birth: | 1955 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 232113 |
| SO#: | 261075 |
| Booked at: | SALT LAKE |
| Cob: | Idaho |
| Booking number: | 0416665 |
| Booking date: | Jul 12, 2004 |
| Release date: | Jul 12, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 041400079 |
| Amount: | $10,000 |