| Date of birth: | 1935 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 1055280 |
| SO#: | 281604 |
| Booked at: | SALT LAKE |
| Cob: | Iowa |
| Citizen: | UNITED STATES |
| Booking number: | 0421759 |
| Booking date: | Sep 10, 2004 |
| Release date: | Sep 12, 2004 |
| Booking location: | Salt Lake County, UT |