| Date of birth: | 1939 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 351929 |
| SO#: | 163568 |
| Booked at: | SALT LAKE |
| Cob: | Ohio |
| Booking number: | 9504480 |
| Booking date: | Feb 28, 1995 |
| Release date: | Feb 28, 1995 |
| Booking location: | Salt Lake County, UT |
| Number: | 204944004745 |
| Amount: | $400 |