| Date of birth: | 1922 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 0215693 |
| SO#: | 123406 |
| Booked at: | SALT LAKE |
| Cob: | Michigan |
| Booking number: | 9519326 |
| Booking date: | Sep 11, 1995 |
| Release date: | Sep 18, 1995 |
| Booking location: | Salt Lake County, UT |
| Number: | 951002136 |
| Amount: | $1,075 |