| Date of birth: | 1921 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 364850 |
| SO#: | 197840 |
| Booked at: | SALT LAKE |
| Cob: | Missouri |
| Booking number: | 9416139 |
| Booking date: | Aug 30, 1994 |
| Release date: | Sep 6, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 5-935002305 |
| Amount: | $1,590 |