| Date of birth: | 1936 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 83856 |
| SO#: | 149361 |
| Booked at: | SALT LAKE |
| Cob: | Illinois |
| Citizen: | UNITED STATES |
| Booking number: | 0414187 |
| Booking date: | Jun 11, 2004 |
| Release date: | Aug 13, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 971900356 |
| Amount: | $25,000 |