| Date of birth: | 1943 |
| Hair: | Gray or partially gray |
| Eyes: | Hazel |
| SO#: | 281115 |
| Booked at: | SALT LAKE |
| Cob: | New York |
| Citizen: | UNITED STATES |
| Booking number: | 0413890 |
| Booking date: | Jun 7, 2004 |
| Release date: | Jun 8, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $1,567 |