| Date of birth: | 1925 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 081417 |
| SO#: | 34409 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9610504 |
| Booking date: | Jun 2, 1996 |
| Release date: | Jun 2, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 961000193MS |