| Date of birth: | 1942 |
| Hair: | Black |
| Eyes: | Brown |
| SO#: | 279886 |
| Booked at: | SALT LAKE |
| Cob: | California |
| Citizen: | UNITED STATES |
| Booking number: | 0409279 |
| Booking date: | Apr 13, 2004 |
| Release date: | Apr 14, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $925 |
| Number: | 04CR04544 |
| Amount: | $1,110 |