| Date of birth: | 1929 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 140847 |
| SO#: | 77201 |
| Booked at: | SALT LAKE |
| Cob: | Illinois |
| Booking number: | 9405402 |
| Booking date: | Mar 25, 1994 |
| Release date: | Apr 20, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 203933005162 |
| Amount: | $1,005 |