| Date of birth: | 1952 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 275529 |
| SO#: | 168851 |
| Booked at: | SALT LAKE |
| Cob: | Nevada |
| Booking number: | 9625894 |
| Booking date: | Dec 27, 1996 |
| Release date: | Dec 27, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 961000458 |
| Amount: | $500 |