| Date of birth: | 1922 |
| Hair: | Gray or partially gray |
| Eyes: | Hazel |
| State id: | 518735 |
| SO#: | 239715 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9922611 |
| Booking date: | Sep 12, 1999 |
| Release date: | Sep 14, 1999 |
| Booking location: | Salt Lake County, UT |
| Amount: | $925 |