| Date of birth: | 1936 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 0231548 |
| SO#: | 176009 |
| Booked at: | SALT LAKE |
| Citizen: | UNITED STATES |
| Booking number: | 0207480 |
| Booking date: | Apr 5, 2002 |
| Release date: | Apr 5, 2002 |
| Booking location: | Salt Lake County, UT |
| Number: | 001913298 |
| Amount: | $3,000 |