| Date of birth: | 1941 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 214128 |
| SO#: | 128195 |
| Booked at: | SALT LAKE |
| Cob: | Oregon |
| Booking number: | 9411952 |
| Booking date: | Jul 1, 1994 |
| Release date: | Aug 8, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 921012157MS |
| Amount: | $1,005 |