| Date of birth: | 1944 |
| Hair: | Brown |
| Eyes: | Green |
| SO#: | 283926 |
| Booked at: | SALT LAKE |
| Cob: | Washington |
| Citizen: | UNITED STATES |
| Booking number: | 0424761 |
| Booking date: | Oct 18, 2004 |
| Release date: | Oct 18, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 04TR05948 |
| Amount: | $1,500 |