| Date of birth: | 1950 |
| Hair: | Blonde |
| Eyes: | Brown |
| State id: | 172663 |
| SO#: | 184081 |
| Booked at: | SALT LAKE |
| Cob: | North Dakota |
| Citizen: | UNITED STATES |
| Booking number: | 0430285 |
| Booking date: | Dec 25, 2004 |
| Release date: | Dec 25, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $200 |