| Date of birth: | 1916 |
| Hair: | Gray or partially gray |
| Eyes: | Brown |
| State id: | 0196983 |
| SO#: | 114809 |
| Booked at: | SALT LAKE |
| Cob: | New Jersey |
| Booking number: | 9512358 |
| Booking date: | Jun 7, 1995 |
| Release date: | Jun 14, 1995 |
| Booking location: | Salt Lake County, UT |
| Amount: | $300 |
| Number: | 931000190 |