| Date of birth: | 1948 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 1060638 |
| SO#: | 281398 |
| Booked at: | SALT LAKE |
| Cob: | Oregon |
| Citizen: | UNITED STATES |
| Booking number: | 0423527 |
| Booking date: | Oct 2, 2004 |
| Release date: | Oct 5, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $5,077 |