| Date of birth: | 1935 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 0903373 |
| SO#: | 51369 |
| Booked at: | SALT LAKE |
| Cob: | Idaho |
| Booking number: | 9526101 |
| Booking date: | Dec 12, 1995 |
| Release date: | Dec 20, 1995 |
| Booking location: | Salt Lake County, UT |
| Number: | 951017507 |
| Amount: | $250 |