| Date of birth: | 1952 |
| Hair: | Brown |
| Eyes: | Brown |
| SO#: | 126692 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0331383 |
| Booking date: | Dec 18, 2003 |
| Release date: | Dec 19, 2003 |
| Booking location: | Salt Lake County, UT |
| Number: | 011201968 |
| Amount: | $1,000 |
| Number: | 011300783 |