| Date of birth: | 1912 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 163043 |
| SO#: | 93960 |
| Booked at: | SALT LAKE |
| Cob: | Pennsylvania |
| Booking number: | 9518477 |
| Booking date: | Aug 31, 1995 |
| Release date: | Aug 31, 1995 |
| Booking location: | Salt Lake County, UT |
| Amount: | $250 |