| Date of birth: | 1943 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 514760 |
| SO#: | 236702 |
| Booked at: | SALT LAKE |
| Cob: | Missouri |
| Booking number: | 9911306 |
| Booking date: | May 7, 1999 |
| Release date: | May 7, 1999 |
| Booking location: | Salt Lake County, UT |
| Amount: | $1,701 |