| Date of birth: | 1939 |
| Hair: | Brown |
| Eyes: | Green |
| State id: | 154435 |
| SO#: | 136121 |
| Booked at: | SALT LAKE |
| Cob: | Nevada |
| Booking number: | 9322220 |
| Booking date: | Dec 20, 1993 |
| Release date: | Jan 26, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 931002772 |
| Amount: | $1,570 |