| Date of birth: | 1943 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 660687 |
| SO#: | 283611 |
| Booked at: | SALT LAKE |
| Cob: | Pennsylvania |
| Booking number: | 0423539 |
| Booking date: | Oct 2, 2004 |
| Release date: | Oct 2, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 040030641 |
| Amount: | $220 |
| Number: | 04CR11669 |
| Amount: | $5,000 |
