| Date of birth: | 1961 |
| Hair: | Black |
| Eyes: | Brown |
| State id: | 313461 |
| SO#: | 164216 |
| Booked at: | SALT LAKE |
| Citizen: | UNITED STATES |
| Booking number: | 0421195 |
| Booking date: | Sep 3, 2004 |
| Release date: | Sep 3, 2004 |
| Booking location: | Salt Lake County, UT |
| Number: | 041101846 |
| Amount: | $5,000 |