| Date of birth: | 1939 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 211957 |
| SO#: | 121481 |
| Booked at: | SALT LAKE |
| Cob: | Kansas |
| Booking number: | 9415490 |
| Booking date: | Aug 21, 1994 |
| Release date: | Aug 21, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 945001182TC |
| Amount: | $2,005 |