| Date of birth: | 1957 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 1046552 |
| SO#: | 278347 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0414379 |
| Booking date: | Jun 13, 2004 |
| Release date: | Jun 13, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 041902178 |
| Amount: | $5,000 |