| Date of birth: | 1945 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 219552 |
| SO#: | 123432 |
| Booked at: | SALT LAKE |
| Cob: | Michigan |
| Booking number: | 9602623 |
| Booking date: | Feb 2, 1996 |
| Release date: | Feb 3, 1996 |
| Booking location: | Salt Lake County, UT |
| Amount: | $50 |
| Number: | 961001345 |
| Amount: | $2,500 |