| Date of birth: | 1939 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 164483 |
| SO#: | 95382 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 0414013 |
| Booking date: | Jun 9, 2004 |
| Release date: | Jun 9, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 041101232 |
| Amount: | $15,000 |