| Date of birth: | 1946 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 311731 |
| SO#: | 162220 |
| Booked at: | SALT LAKE |
| Cob: | Kansas |
| Citizen: | UNITED STATES |
| Booking number: | 0407623 |
| Booking date: | Mar 26, 2004 |
| Release date: | Mar 30, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 941021620 |
| Amount: | $2,430 |