| Date of birth: | 1930 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 087480 |
| SO#: | 40862 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9517885 |
| Booking date: | Aug 24, 1995 |
| Release date: | Sep 22, 1995 |
| Booking location: | Salt Lake County, UT |
| Number: | 935000016 |
| Amount: | $505 |
| Number: | T35007 |