| Date of birth: | 1925 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 142804 |
| SO#: | 78416 |
| Booked at: | SALT LAKE |
| Cob: | Arizona |
| Booking number: | 9401438 |
| Booking date: | Jan 22, 1994 |
| Release date: | Jan 25, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 925008060 |
| Amount: | $670 |