| Date of birth: | 1938 |
| Hair: | Brown |
| Eyes: | Brown |
| State id: | 068689 |
| SO#: | 36559 |
| Booked at: | SALT LAKE |
| Cob: | Colorado |
| Citizen: | UNITED STATES |
| Booking number: | 0414383 |
| Booking date: | Jun 13, 2004 |
| Release date: | Jun 24, 2004 |
| Booking location: | Salt Lake County, UT |
| Amount: | $280 |
| Number: | 02CR04263 |
| Amount: | $1,000 |
| Number: | 041902986 |
| Amount: | $20,000 |
