| Date of birth: | 1940 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| SO#: | 284801 |
| Booked at: | SALT LAKE |
| Cob: | Colorado |
| Citizen: | UNITED STATES |
| Booking number: | 0427962 |
| Booking date: | Nov 26, 2004 |
| Release date: | Nov 30, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $12,405 |