| Date of birth: | 1944 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 280253 |
| SO#: | 197556 |
| Booked at: | SALT LAKE |
| Cob: | Indiana |
| Booking number: | 9415181 |
| Booking date: | Aug 17, 1994 |
| Release date: | Sep 9, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 912012882 |
| Amount: | $670 |