| Date of birth: | 1938 |
| Hair: | Brown |
| Eyes: | Green |
| State id: | 309198 |
| SO#: | 161580 |
| Booked at: | SALT LAKE |
| Cob: | West Virginia |
| Booking number: | 9504799 |
| Booking date: | Mar 3, 1995 |
| Release date: | Mar 4, 1995 |
| Booking location: | Salt Lake County, UT |
| Number: | 902006253 |
| Amount: | $1,505 |