| Date of birth: | 1927 |
| Hair: | Gray or partially gray |
| Eyes: | Blue |
| State id: | 154022 |
| SO#: | 89201 |
| Booked at: | SALT LAKE |
| Cob: | Arizona |
| Booking number: | 9824380 |
| Booking date: | Oct 21, 1998 |
| Release date: | Oct 21, 1998 |
| Booking location: | Salt Lake County, UT |
| Amount: | $100 |