| Date of birth: | 1946 |
| Hair: | Black |
| Eyes: | Brown |
| SO#: | 282127 |
| Booked at: | SALT LAKE |
| Cob: | New York |
| Citizen: | UNITED STATES |
| Booking number: | 0417747 |
| Booking date: | Jul 25, 2004 |
| Release date: | Jul 28, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $925 |
| Number: | 04CR09741 |
| Amount: | $555 |