| Date of birth: | 1933 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 097918 |
| SO#: | 160797 |
| Booked at: | SALT LAKE |
| Cob: | Kansas |
| Booking number: | 9416951 |
| Booking date: | Sep 10, 1994 |
| Release date: | Oct 28, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 921014290 |
| Amount: | $640 |
| Number: | NA |
| Amount: | $550 |
