| Date of birth: | 1929 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 152413 |
| SO#: | 85594 |
| Booked at: | SALT LAKE |
| Cob: | Massachusetts |
| Citizen: | UNITED STATES |
| Booking number: | 0921090 |
| Booking date: | Jul 29, 2009 |
| Release date: | Jul 29, 2009 |
| Booking location: | Salt Lake County, UT |
| Amount: | $555 |