| Date of birth: | 1938 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| SO#: | 283439 |
| Booked at: | SALT LAKE |
| Cob: | Idaho |
| Citizen: | UNITED STATES |
| Booking number: | 0422858 |
| Booking date: | Sep 24, 2004 |
| Release date: | Sep 28, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $890 |
| Number: | 04CR13001 |
| Amount: | $640 |