| Date of birth: | 1911 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 369628 |
| SO#: | 182976 |
| Booked at: | SALT LAKE |
| Cob: | California |
| Booking number: | 9406093 |
| Booking date: | Apr 4, 1994 |
| Release date: | May 3, 1994 |
| Booking location: | Salt Lake County, UT |
| Number: | 921901691FS |