| Date of birth: | 1939 |
| Hair: | Brown |
| Eyes: | Green |
| State id: | 172150 |
| SO#: | 83611 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 0127720 |
| Booking date: | Nov 11, 2001 |
| Release date: | Nov 12, 2001 |
| Booking location: | Salt Lake County, UT |
| Number: | 012003981 |
| Amount: | $750 |