| Date of birth: | 1946 |
| Hair: | Brown |
| Eyes: | Hazel |
| State id: | 286202 |
| SO#: | 277494 |
| Booked at: | SALT LAKE |
| Cob: | Rhode Island |
| Booking number: | 0400030 |
| Booking date: | Jan 1, 2004 |
| Release date: | Jan 6, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 031500787 |
| Amount: | $5,000 |