| Date of birth: | 1929 |
| Hair: | Brown |
| Eyes: | Blue |
| State id: | 300703 |
| SO#: | 165283 |
| Booked at: | SALT LAKE |
| Cob: | Washington |
| Booking number: | 9615197 |
| Booking date: | Aug 14, 1996 |
| Release date: | Aug 14, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 961016027 |
| Amount: | $5,000 |