| Date of birth: | 1942 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 151258 |
| SO#: | 173504 |
| Booked at: | SALT LAKE |
| Cob: | Nebraska |
| Booking number: | 9625258 |
| Booking date: | Dec 18, 1996 |
| Release date: | Dec 18, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 961000352 |
| Amount: | $5,000 |