| Date of birth: | 1938 |
| State id: | 154710 |
| SO#: | 84694 |
| Booked at: | SALT LAKE |
| Booking number: | 9601811 |
| Booking date: | Jan 23, 1996 |
| Release date: | Feb 9, 1996 |
| Booking location: | Salt Lake County, UT |
| Booking location: | Salt Lake County, UT |
| Number: | 955012445 |
| Amount: | $254 |