| Date of birth: | 1945 |
| Hair: | Brown |
| Eyes: | Hazel |
| State id: | 230400 |
| SO#: | 99324 |
| Booked at: | SALT LAKE |
| Cob: | Arizona |
| Citizen: | UNITED STATES |
| Booking number: | 0423036 |
| Booking date: | Sep 26, 2004 |
| Release date: | Sep 26, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $1,590 |
| Number: | 931014045 |
| Amount: | $5,000 |