| Date of birth: | 1947 |
| Hair: | Brown |
| Eyes: | Brown |
| SO#: | 279198 |
| Booked at: | SALT LAKE |
| Cob: | Texas |
| Citizen: | UNITED STATES |
| Booking number: | 0406561 |
| Booking date: | Mar 15, 2004 |
| Release date: | Mar 15, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 031901825 |
| Amount: | $5,000 |