| Date of birth: | 1973 |
| Hair: | Brown |
| Eyes: | Green |
| SO#: | 353353 |
| Booked at: | SALT LAKE |
| Cob: | Oregon |
| Citizen: | UNITED STATES |
| Booking number: | 12005222 |
| Booking date: | Jan 30, 2012 |
| Release date: | Jan 30, 2012 |
| Booking location: | Salt Lake County, UT |
| Offense date: | Jan 30, 2012 |
| Grade: | F |
| Description: | Obtain Controlled Substance by Fraud/Misrepresentation |
| Degree: | 3 |
| Code: | 58.37.8.3.A.ii |
| Case number: | 121900692 |
| Offense date: | Jan 30, 2012 |
| Grade: | F |
| Description: | Utter/forge/alter a prescription |
| Degree: | 3 |
| Code: | 58.37.8.3.A.iii |
| Case number: | 121900692 |
| Number: | 121900692 |
