| Date of birth: | 1949 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 452640 |
| SO#: | 212647 |
| Booked at: | SALT LAKE |
| Cob: | Oregon |
| Booking number: | 9617825 |
| Booking date: | Sep 16, 1996 |
| Release date: | Sep 16, 1996 |
| Booking location: | Salt Lake County, UT |
| Amount: | $294 |
| Number: | 4-964003814 |
| Amount: | $505 |