| Date of birth: | 1921 |
| Hair: | Gray or partially gray |
| Eyes: | Hazel |
| State id: | 0351273 |
| SO#: | 212490 |
| Booked at: | SALT LAKE |
| Cob: | Utah |
| Booking number: | 9612703 |
| Booking date: | Jul 16, 1996 |
| Release date: | Jul 16, 1996 |
| Booking location: | Salt Lake County, UT |
| Number: | 961014125FS |
| Amount: | $1,500 |