| Date of birth: | 1934 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 279073 |
| SO#: | 156958 |
| Booked at: | SALT LAKE |
| Cob: | Wyoming |
| Booking number: | 9520498 |
| Booking date: | Sep 27, 1995 |
| Release date: | Sep 27, 1995 |
| Booking location: | Salt Lake County, UT |
| Amount: | $600 |
| Number: | D621/076 |
| Amount: | $300 |