| Date of birth: | 1934 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 467780 |
| SO#: | 218053 |
| Booked at: | SALT LAKE |
| Cob: | Indiana |
| Booking number: | 9704658 |
| Booking date: | Feb 26, 1997 |
| Release date: | Feb 28, 1997 |
| Booking location: | Salt Lake County, UT |
| Amount: | $257 |
| Number: | 965000965 |
| Amount: | $117 |