| Date of birth: | 1932 |
| Hair: | Bald |
| Eyes: | Brown |
| State id: | 107919 |
| SO#: | 53782 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9410930 |
| Booking date: | Jun 16, 1994 |
| Release date: | Jun 28, 1994 |
| Booking location: | Salt Lake County, UT |
| Amount: | $430 |
| Number: | 925011255 |
| Amount: | $405 |