| Date of birth: | 1950 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 1051607 |
| SO#: | 280189 |
| Booked at: | SALT LAKE |
| Cob: | Michigan |
| Citizen: | UNITED STATES |
| Booking number: | 0410379 |
| Booking date: | Apr 26, 2004 |
| Release date: | Apr 26, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 011919311 |
| Amount: | $5,000 |