| Date of birth: | 1952 |
| Hair: | Brown |
| Eyes: | Blue |
| SO#: | 284490 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Citizen: | UNITED STATES |
| Booking number: | 0426790 |
| Booking date: | Nov 12, 2004 |
| Release date: | Nov 12, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $1,850 |
| Number: | 04-10319 |
| Amount: | $1,500 |