| Date of birth: | 1938 |
| Hair: | Black |
| State id: | 636112 |
| SO#: | 280588 |
| Booked at: | SALT LAKE |
| Cob: | EGYPT |
| Citizen: | UNITED STATES |
| Booking number: | 0412019 |
| Booking date: | May 16, 2004 |
| Release date: | May 16, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 041100987 |
| Amount: | $5,000 |