| Date of birth: | 1944 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 163005 |
| SO#: | 94177 |
| Booked at: | SALT LAKE |
| Cob: | Colorado |
| Citizen: | UNITED STATES |
| Booking number: | 0625075 |
| Booking date: | Sep 23, 2006 |
| Release date: | Sep 23, 2006 |
| Booking location: | Salt Lake County, UT |
| Amount: | $2,055 |
| Number: | T05-16581 |
| Amount: | $175 |