| Date of birth: | 1944 |
| Hair: | Brown |
| Eyes: | Hazel |
| State id: | 111213 |
| SO#: | 55291 |
| Booked at: | SALT LAKE |
| Cob: | South Dakota |
| Citizen: | UNITED STATES |
| Booking number: | 0400079 |
| Booking date: | Jan 1, 2004 |
| Release date: | Jan 8, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 99-01397 |
| Amount: | $1,500 |